Consultation response submitted by Prof Bob Steele and Prof Annie S. Anderson, Co-directors of the SCPN to the Scottish Government’s Reducing Health Harms of Foods High in Fat, Sugar or Salt Consultation Paper
The Scottish Cancer Prevention Network (SCPN) is focused on moving evidence on cancer risk reduction into everyday life, practice and policy (https://www.cancerpreventionscotland.org.uk/). Obesity is a major, modifiable risk factor for 13 cancers including breast and colorectal and also impacts on the well-being of people who have had a cancer diagnosis. Whilst it is recognised that governments do much to support changing behaviours relating to lifestyle factors including diet and physical activity we also recognise that there is a need to increase capacity around cancer prevention and screening, and there is much more that agencies and government work streams can do to help to accelerate change. As an advocacy group we raise the profile of cancer prevention and screening research and action through a range of communication channels (newsletter, conference, workshops, social media and web-based activities) and support ongoing work in reducing the prevalence of cancer risk factors. The SCPN is funded by the Scottish Cancer Foundation charity (SCO28300).
To what degree do you agree or disagree that mandatory measures should be introduced to restrict the promotion and marketing of foods high in fat, sugar or salt to reduce health harms associated with their excessive consumption?
There is considerable evidence from tobacco control that can be applied to changing other health behaviours. The classic approach in social marketing is to think about a combination of the product (e.g. food composition, portion size), the price (e.g. sugary drink taxation), placements (availability of junk products) and promotions (e.g. money off deals, upselling). The UK and Scottish Governments have clearly declared action on promotions, one regulatory action on price (taxation on sugary drinks) and guidance about product composition (sugar and salt content).
Voluntary action on any of these four domains have had limited success and there are no further options suggested than to consider mandatory approaches on all four areas including promotions.
It is unlikely that restricting promotions without also reducing availability and widespread pricing measures will have the required effect on food purchase and subsequent dietary intake. There is considerable evidence on the effects of pricing policy and decreased consumption which suggests that a combined approach of decreasing promotions coupled with pricing policy would have a greater impact.
Should this policy only target discretionary foods? [Confectionery, sweet biscuits, crisps, savoury snacks, cakes, pastries, puddings and soft drinks with added sugar]
No there are other foods that should be targeted.
The rationale behind the approach of targeting categories of discretionary foods is evidence based, practical and has merit. However, there are many other foods that are heavily promoted within Scotland that contribute to excessive calorie intake and saturated fat (relevant to achieving the dietary goals) including savoury pies and other processed meat products which are undesirable due to their association with an increased risk of colorectal cancer. In addition, current government recommendations highlight the use of low fat dairy products and routes to effective reductions in cream, butter, spreading fats, high fat cheeses, yogurts, milks, and processed meats remain a challenge.
Using a nutrient profile (updated) would allow a more generic and systematic approach to targeting which is consistent with all dietary messages. The current emphasis on sugar rich foods detracts from the overall diet quality messages around excess fat (the most energy dense nutrient). Whilst action to reduce many of these discretionary foods will impact on fat, the visible message to the public re-enforces the dangers of sugar rather than sugar and fat.
Should this policy treat ice-cream and dairy desserts as discretionary foods?
Promotions of all ice–cream and all dairy desserts (frozen and non-frozen) should be included. Clear definitions are essential. These foods are high in calories and saturated fats (and sugar) and have little nutritional merit and need for promotion. Alternative low fat, low sugar desserts (including plant based options) which can meet agreed nutrient standards are desirable.
Please comment on our approach to defining categories and exclusions of particular foods/products from those definitions (paragraphs 9-11)?
It is important that all appropriate categories are defined including processed meats.
Exceptions run the danger of adding more complexity to work which is already quite ambitious. The possibility of promoting sugar free sweets implies these have potential for positive benefits. Promoting any foods which do not fit with the Scottish dietary goals seems inappropriate and prolong the cultural acceptability of a “sweet tooth”. Additionally a recent review in the British Medical Journal (https://www.bmj.com/content/364/bmj.k4718) reports no major impact of sugar substitutes on body weight.
Yes – these are aimed at encouraging a lack of awareness of portion size.
Allowing temporary price reductions provides a perfect loop hole for the promotion of foods which we wish to decrease. Temporary price reductions are likely to be most notable for seasonal products. For example the FSS reported an increase in calorie purchase of around 10% each day for the 12 weeks up to the end of the festive period (https://www.foodstandards.gov.scot/downloads/Food_and_Drinks_Purchased_into_The_Home_in_Scotland_report.pdf).
It would be cautionary not to permit promotion of these without specific evidence to demonstrate they do not have an impact on excess purchase.
Please comment on the approach we are proposing to take to restricting forms of promotion and marketing outlined in section 5.
Generally this is a useful list of the more obvious in-store promotions.
It is disappointing to exclude price marked packs and represents a clear way forward for promotions of food that we do not wish to see promoted. Within the HRS the criterion of less than 25% of front of pack is somewhat generous given that some vital details like quantity in pack takes up less than 10% of the pack.
A clear definition is needed on placement at check outs. It should be possible to give this within distance in metres in all retail settings but especially small newsagent type shops. This has been done well in tobacco control.
Should the restrictions apply to any place where targeted foods are sold to the public, except where they are not sold in the course of business (e.g. charity bake sales)?
Yes – this should include catering establishments that provide take away services and all forms of transport.
As a group supported by a cancer charity we cannot agree with any promotion of bake sales for fund raising and every attempt should be made to reduce an emphasis on discretionary foods in these settings even if they are not covered by this proposed promotional restrictions. Our culture of promoting cake, biscuits and pastries needs to change.
Please comment on whether, and if so to what extent, restrictions should be applied online.
Yes – online shopping must be included in order to have a level playing field amongst retail outlets.
Should restrictions to displaying targeted foods at end of aisle, checkouts etc. not apply where there is no reasonable alternative to displaying them elsewhere?
Exemptions open the way for manipulation and should be avoided. Close monitoring is important.
Should food marked as discounted because it is close to expiry be exempt from positioning restrictions (end of aisle, checkouts etc.) and/or ‘promotion of value’ restrictions?
Exemptions allow loopholes to be exploited. Many retail outlets offer shelf space to foods close to “use by dates” and shoppers seem to find these without specific promotion locations.
Please list any other exemptions we should consider.
Please comment on our proposals for enforcement and implementation outlined in section 8.
These appear to be appropriate and it is important that monitoring findings are publically available.
Please comment on the proposed flexible approach outlined in section 9.
This seems appropriate
If you sell, distribute or manufacture discretionary foods, please comment on how the restrictions in this consultation paper would impact you.
What support do sellers, distributors and manufacturers need to implement the restrictions effectively?
How would the proposed restrictions impact on the people of Scotland with respect to age, disability, gender reassignment, pregnancy and maternity, ethnicity, religion or belief, sex, sexual orientation or socioeconomic disadvantage?
Please consider both potentially positive and negative impacts, supported by evidence, and, if applicable, advise on any mitigating actions we should take.
We do not see any negative consequences but it is important that the impact is monitored. This is particularly important with respect to foods which should not currently be increased (e.g. processed meat products).
Please outline any other comments you wish to make.
Exemptions diminish the potential of the proposed actions. In particular, temporary and seasonal promotions offer considerable scope for undesirable promotions.
A clear framework for monitoring is needed and dates for reporting and review.
Current legislation which forbids marketing of breast milk substitutes is crucial. Further action may be needed to avoid promotion of “follow on milks”. The only baby milks which need to be promoted in Scotland is breast milk which is associated with appropriate growth trajectories in babies and infants and lower levels of (pre and post-menopausal) breast cancer and obesity in mothers (https://www.ncbi.nlm.nih.gov/pubmed/26116994).