Republic of the Philippines
DEPARTMENT OF HEALTH
Office of the Secretary
BAGONG PILIPINAS
July 29, 2024
DEPARTMENT CIRCULAR
No. 2024 - 029(
FOR:
UNDERSECRETARIES AND ASSISTANT SECRETARIES;
DIRECTORS OF BUREAUS, SERVICES AND CENTERS FOR
HEALTH
OF
HEALTH
MINISTER
DEVELOPMENT;
BANGSAMORO
AUTONOMOUS
IN
MUSLIM
REGION
MINDANAO;
EXECUTIVE DIRECTORS OF
SPECIALTY
HOSPITALS; CHIEFS OF MEDICAL CENTERS, HOSPITALS,
SANITARIA
AND
AND
INSTITUTES:
TREATMENT
REHABILITATION CENTERS; AND ALL OTHERS CONCERNED
SUBJECT:
Public Consultation of the draft Administrative Order entitled,
“National Policy on the Promotion of Healthy Diets”
ALL
This is to request submission of inputs and comments on the attached draft Department of
Health (DOH) Administrative Order (AO) entitled, “National Policy on the Promotion of
Healthy Diets.”
The consumption of unhealthy diets, characterized by high intake of foods high in sodium,
sugar, and fat, continues to drive the prevalence of different forms of malnutrition and
noncommunicable diseases among Filipinos. To address this, concerted efforts to promote the
consumption of healthier diets by addressing the wider determinants of malnutrition and
noncommunicable diseases should be scaled up. The draft AO specifically aims to outline the
direction and strategies across the food systems pathway that will contribute to the reduction
of population-wide consumption of sodium, sugar, and fat to promote healthy diets.
Relative thereto, all concerned stakeholders are enjoined to send in their inputs and comments
on the draft DOH AO on or before August 20, 2024, through this link: bit.ly/DOH-AO-HD.
Alternatively, you may also submit your inputs directly to the DOH Health Promotion Bureau
at ppsrdhpb@doh.gov.ph. A copy of the draft policy is accessible at bit.ly/AO-HD-V 1. Please
indicate the page and line number of the provision being referred to for ease of reference.
Dissemination of the information to all concerned is requested.
By Authority of the Secretary of Health:
Undersecretary of Health
Public Health Services Cluster
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1108,
1111,
Direct Line: 711 9502; 711 9503 Fax: 743-1829e URL: http://www.doh.gov.ph; e-mail: dohosec@doh.gov.ph
1112, 1113
Republic of the Philippines
DEPARTMENT OF HEALTH
Office of the Secretary
BAGONG PILIPINAS
1
ADMINISTRATIVE ORDER
2 No. 2024 3
4
SUBJECT:
5
National Policy on the Promotion of Healthy Diets
6
7
RATIONALE
IL.
8
Non-communicable diseases (NCDs) such as cardiovascular diseases, chronic respiratory
10 disease, diabetes, and cancer remain to be the leading cause of death in the Philippines (PSA,
11 2022). In 2019, 5 million Filipinos were reported to suffer from cardiovascular diseases,
12 while 3 million suffer from the health and lifestyle consequences of diabetes (DOH
13 Epidemiology Bureau, 2019). NCDs cause significant impact in health care costs, as well as
14 social care and welfare support needs for typical Filipino families.
9
15
the top modifiable risk factors of NCDs is unhealthy diets, characterized by high
High intake of such nutrients have been linked
18 to adverse health consequences such as elevated blood
pressure, abnormal blood lipid levels,
19 elevated blood glucose, as well as obesity. With the Philippines experiencing the triple burden
20 of malnutrition, on one end having thousands of Filipinos suffering from undernutrition and
21 micronutrient deficiencies, and on the other suffering from obesity and overnutrition, it is
22 crucial for interventions to shift its focus on the food system as a whole, to be sensitive to the
23 needs of both the undernourished and the overnourished.
16 Among
17 intake of food high in sodium, sugar, and fat.
24
25 A
whole-of-system approach to alleviating malnutrition has long been recognized, however
the core link between our food
27 systems and its corresponding impact to health. The High Level Panel of Experts on Food
28 Security identified three elements of the food system that are entry and exit points for
29 nutrition namely: (1) food supply, (2) food environment, and (3) consumer behaviors. With
30 this, the aforementioned elements are key entry points for the health sector to employ
31 strategies to improve health and nutrition outcomes.
26 further efforts are needed for public policies to be cognizant of
32
view of the foregoing, the Department of Health (DOH) issues this national policy to
the strategic directions to foster healthy food systems to reduce population-level
35 intake of sodium, sugar, and fat and to promote healthy dietary behaviors.
33 In
34 outline
36
a7 IL
38
OBJECTIVES
39 This
Order aims to provide strategic directions to reduce population-level consumption of
sugar, and fat for the promotion of healthy diets. Specifically, this Order shall
41 provide direction and key strategies to:
42
a. Make healthy food options available and accessible to improve population diet
43
quality; and
b. Promote healthy dietary behaviors through improved health and nutrition literacy.
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40 sodium,
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48
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila
® Trunk Line 8651-7800 local 1108, 1111, 1112, 1113
Direct Line: 8711-9502; 8711-9503 Fax: 8743-1829 e URL: http://www.doh.gov.ph; e-mail: dohosec@doh.gov.ph
SCOPE OF APPLICATION
49I1I.
50
51 This Order shall apply to all DOH Central Office Bureaus and Services, Centers for Health
52 Development, hospitals, treatment and rehabilitation centers, other health facilities, partners
53 from National Government Agencies, Local Government Units, non-government or civil
54 society organizations, development partners, the academe, and all others involved in the
55 implementation of policies, projects, and programs for the promotion of healthy diets.
56
57 In the case of the Bangsamoro Autonomous Region in Muslim Mindanao, the adoption
58 this
of
Order shall be in accordance with RA No. 11054 or the Bangsamoro Organic Act and the
59 subsequent laws and issuances
be issued by the Bangsamoro government.
to
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DEFINITION OF TERMS
61 IV.
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A. Food Establishment - refer to a sole proprietorship, a partnership, a corporation, an
institution, an association, or an organization engaged in the manufacture,
importation, exportation, sale, offer for sale, distribution, donation, transfer, use,
testing, promotion, advertising, or sponsorship of health products including the
facilities and installations needed for
activities.
its
B.
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preferences.
3.
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C.
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Consumer Behaviors/Food Consumption — refers to all the choices and
decisions made by consumers, at the household or individual level, on what
food to acquire, store, prepare, cook and eat, and on the allocation of food
within the household (including gender repartition and feeding of children).
It is influenced by personal preferences and shaped by the existing food
environment.
Food High in Sodium, Sugar, and Fat - refers to food products that exceed set
nutritional quality standards for sodium, sugar, and saturated fat and/or contain trans
fatty acids respectively.
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Food System Entry Points®
1. Food Supply — refers to the processes and activities that influence the
supply of nutritious food and/or the nutritional quality of food.
2. Food Environments — refers to the physical, economic, socio-cultural and
policy conditions that shape access, affordability, safety and food
D.
Food Service Establishment - refer to any establishment duly licensed with business
permits issued by the local government units, offering to the public, regular and
special meals or menu, cooked food, and short orders.
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E.
Healthy Food Options - for the purpose of this policy, healthy food options refer to
food that adhere to nutritional quality standards.
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F.
Healthy Diet - one in which macronutrients are consumed in appropriate proportions
to support energetic and physiologic needs without excess intake while also providing
sufficient micronutrients and hydration to meet the physiologic needs of the body.>
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G.
Marketing — refers to any form of commercial communication of messages that has
an aim, effect or likely effect of increasing the recognition, appeal and/or
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consumption of particular products, brands and services, either directly or indirectly.
It comprises anything that acts to advertise or otherwise promote a product or
service’, including the advertising of corporate social responsibility initiatives. This
broad definition of marketing is intended to cover the wide breadth of marketing
strategies, including, but not limited to, advertising, sponsorship, direct marketing
(e.g. mail, text), product placement and branding.’
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Nutrient Profiling — refers to the science of classifying or ranking foods according to
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their nutritional composition for reasons related to preventing disease and promoting
health.*
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Nutrition Sensitive Interventions - refer to interventions that influence the broader
determinants of malnutrition, but are not aimed at directly or immediately addressing
or improving the nutritional status of individuals or groups.
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ready
Prepackaged Food - refers to packaged food or food made in advance in a container,
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.
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.
Unhealthy Food Options - for the purpose of this policy, unhealthy food options
refer to food high in sodium, sugar, and fat.
GUIDING PRINCIPLES
.
Evidence-based. The key strategies outlined in this national policy shall be informed
by scientific research and global best practices. Relevant stakeholders shall utilize
both local and international research in developing plans, policies, programs, and
activities for the promotion of healthy diets.
.
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140 VI.
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Micro-, small, and medium enterprises — refers to food business operators as
defined within the classification of industries by the Department of Trade and
Industry (DTI).
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113 V.
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forsale, delivery, and consumption, or for catering purposes.
.
Multi-sectoral
collaboration and partnership. Recognizing the broader
determinants of malnutrition, key strategies to reduce population-level sodium,
sugar,
and fat consumption shall foster multi-sectoral collaborations and partnerships
among
actors from national government agencies, local government units, non-government
organizations, civil society, and academe. A whole-of-system, whole-of-government,
and whole-of-society approach shall be employed in the development and
implementation of relevant plans, policies, programs, and activities.
Socioeconomic equity and rights-based. Access to healthy food options and the
attainment of a healthy diet is a basic human right. As such, the development and
implementation of nutrition plans, policies, programs, and activities must be
cognizant of its equity considerations and implications, especially to the vulnerable
population.
.
Precedence of public health over other interests. In recognition that nutrition plays
fundamental role in overall health and well-being, public health shall take
precedence at all times over and above other concerns or interests, especially in
government or public offices involved in the development and implementation of
a
plans, policies, programs, and activities for the promotion of healthy diets.
GENERAL GUIDELINES
A. Efforts
to
diets
shall
healthy
promote
adopt
a
whole-of-system,
whole-of-government, and whole-of-society approach. As such, strategies to achieve
the goal and objectives of this Order shall be identified and aptly categorized through
the pillars of the food systems pathway (Annex A), which shall include interventions
aimed at improving the quality of the Philippine food supply, fostering healthy food
environments, and increasing individual appreciation at the impact of food to health
through improved health and nutrition literacy.
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Recognizing the burden of diseases associated with high consumption of sodium,
sugar, saturated fat, and trans-fat, research and surveillance of food high in the
aforementioned, as well as dietary intake of the aforementioned nutrients of concern
among Filipinos shall be made a priority. Likewise, the necessary social preparation
activities shall be developed as the food system endeavors to reduce population-level
sodium, sugar, and fat intake.
and implementation of guidelines to support strategies to reduce
population-wide consumption of sodium, sugar, and fat shall be aligned with the goals
of the public health sector and shall be protected from any form of conflicts of interest
or interference by the food and beverage industry, including the milk industry
pursuant to Executive Order (EO) No. 51, s. 1986.
C. The development
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SPECIFIC GUIDELINES
A. Food supply interventions
1. Incentives for the production of food
necessary for a healthy diet. The
production and adequate supply of food necessary for a healthy diet is a
prerequisite to shift consumer preference and consumption away from food
high in sodium, sugar, and fat. In this regard, measures that will incentivize the
production of these healthy food options, including but not limited to the
provision of financial and technical assistance to farmers and producers, shall
be developed and provided through close collaboration with relevant
government agencies and partners and stakeholders.
2.
population-level consumption of sodium, sugar, and fat. As such, nutritional
quality standards, including but not limited to a nutrient profile model which
outlines nutrient content thresholds for prepackaged food products shall be
developed and adopted. All nutrition quality standards shall be periodically
reviewed to ensure its alignment with most recent scientific evidence.
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3.
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4.
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Nutritional quality standards. Food that is produced, distributed, and
otherwise marketed in the Philippine market shall contribute in reducing
Food reformulation. In order to ensure compliance with nutritional quality
standards, food establishments shall endeavor to reformulate their food
products especially if found to contain high amounts of sodium, sugar, and fat.
Reformulation techniques and technologies shall be developed and pursued,
and necessary assistance and capacity building activities shall be provided to
food establishments, particularly to micro-, small and medium enterprises to
ensure their adherence to nutritional quality standards.
Food fortification. Nutritional quality of food, particularly those consumed as
part of the Filipino diet, shall be continuously improved. Food fortification
techniques and technologies that aim to add back lost nutrients and/or increase
the nutritional quality of food shall be pursued and implemented. Republic Act
(RA) No. 8976 or the “Philippine Food Fortification Act of 2000,” and RA
No. 8172 or the “ASIN Law” and RA No. 11985 or the “Philippine Salt
Industry Development Act,” which provided the mandatory fortification of
several food items
implemented.
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B.
micronutrients
shall be strictly
sustained
and
Food environment interventions
1%
Measures to increase availability, accessibility, and affordability of food
necessary for a healthy diet. Food necessary for a healthy diet shall be
physically available, easily accessible, and generally affordable to shift
consumption away from food high in sodium, sugar, and fat. As such,
measures that aim to address this shall be intensified to ensure Filipinos meet
recommended energy and nutrient intakes (RENI) and attain healthy diets.
Such measures shall include but are not limited to:
a. Improved storage facilities and transport infrastructures; and
b. Increased linkage of farmers and smallholders to community markets.
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Procurement offood using public funds. No public funds shall be utilized to
procure food that is not in accordance to set nutritional quality standards,
and/or contain high amounts of sodium, sugar, and fat. For this purpose,
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standards on the procurement, provision, and service of food products in
institutions
government-administered
and
and/or
government-funded
organized activities shall be developed. The standards shall include
and service of food during
food in
procurement
emergencies,
community-based feeding activities, food in public hospitals and government
offices, among others.
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4.
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with
C.
Price and fiscal measures. Novel strategies to influence consumer preference
and demand for food necessary for a healthy diet shall be developed. Price and
fiscal measures in the form of taxes and subsidies shall be pursued, as
applicable. RA No. 10963 or the “TRAIN Law”, which imposed taxes on
sweetened beverages shall likewise be raised, sustained, and reviewed to
account for inflation and per capita income growth.
Regulations on marketing. Marketing of food high in sodium, sugar, and fat
has shown to significantly influence and shape consumer behaviors toward its
consumption. As such, regulatory mechanisms to restrict and/or limit the
marketing of these foods across all modes, platforms, and settings shall be
developed and implemented.
Interventions to influence consumer behaviors
1. Implement Social and Behavioral Change Communication (SBCC) campaigns -
SBCC campaigns and activities using traditional tri-media, emerging platforms
and modalities, and on-the-ground or community-level activities shall be
scaled-up to reach target populations and improve individual knowledge,
attitudes, and practices related to the attainment of a healthy diet. Key
messages on the following shall also be developed and disseminated, in
acknowledgement of their influence to overall health.
a.
Infant and Young Child Feeding.
Dietary behaviors are highly
influenced by maternal nutrition and infant and young child feeding
practices. As such, it is crucial for SBCC strategies to highlight the
importance of exclusive breastfeeding and proper complementary
feeding practices in order to shape healthy eating behaviors at an early
age.
b. Healthy Diets. Complementary to efforts to improve the food supply
and food environment
the shared understanding of what constitutes a
diet.
As such, continued messaging on the elements of a
healthy
healthy diet (i.e. balance, variety, and moderation) must be
emphasized.
c. Physical Activity. In addition to healthy eating behaviors, the
incorporation of physical activity in individual lifestyles also improves
health and nutrition outcomes and protects from the risk of developing
NCDs.
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2.
cumulative health effects from consuming a food shall be made available to
consumers. This mandate has been primarily implemented through the
imposition of nutrition labels in prepackaged food products. In this regard,
novel strategies to make nutrition information easily comprehensible and
readily-available,
including but not limited to the development of
front-of-package labels, restaurant menu labeling, among others shall be
pursued and developed.
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Provision of nutrition information. Section 5 of RA No. 10611 or the “Food
Safety Act of 2013” has mandated that information that will aid consumers in
avoiding specific, and/or probable immediate, short-term, long-term, or
D.
Implementation Mechanisms
The following implementation mechanism shall be established and maintain to
accelerate the above mentioned strategies for the reduction of population-level
consumption of sodium, sugar, and fat and promotion of healthy diets:
1.
Governance
The public health sector shall continue to carry its duties in the promotion
of healthy diets and employ the above provided strategies for the reduction
and management of population-level sodium, sugar, and fat intake. For this
purpose:
i.
The DOH Health Promotion Bureau (HPB) shall serve as the
national lead oversight office for the implementation of this Order.
b. The Interagency Technical Working Group on Healthy Diets (IATWG-HD)
shall serve as the official platform to discuss the development and
implementation of strategies for the reduction of population-level sodium,
sugar, and fat intake and promotion of healthy diets. The DOH, as the
Chairperson, shall invite relevant stakeholders
take part in the quarterly
the
IATWG-HD,
of
meetings
necessary.
a.
as
to
2. Legislation and Policy
a. Enactment of laws, issuances, and other policy measures shall be advocated
in collaboration with relevant partners and stakeholders among the national
government, local government units, civil society, and the academe to
achieve the objectives of this Order.
b. A policy and legislative agenda informed by global and local evidence,
international commitments, and comprehensive stakeholder consultation
shall be jointly developed to guide the legislative advocacy and policy
development initiatives in support to the strategies reducing the
population-level consumption of sodium, sugar, and fat intake and
promotion of healthy diets.
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3.
Capacity Development
a.
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4.
Collaboration, Networking, and Partnerships
The public health sector shall foster collaboration with other national and
local government agencies, non-government and/or civil society
a.
organizations, international and local development partners, the academe,
and other entities with similar goals and objectives, in the planning and
development, enforcement or implementation, and monitoring of the
implementation of the strategies outlined in this Order.
No collaboration, partnership, or any engagement with the industry,
particularly the food, beverage, milk, alcohol, and tobacco industries, their
associate enterprises, organizations that represent them, foundations wholly
or partly government or controlled by them, including organizations or
entities receiving financial and technical support from them as well as
individuals working to promote their interests, shall be pursued,
maintained, and/or permitted.
5.
Research, Surveillance, Monitoring and Evaluation
Health policy and systems research, including but not limited to impact
a.
evaluation, economic evaluation, and national and local surveys, shall be
provided with adequate resources to inform decision making on the
reduction of population-wide sodium, sugar, and fat consumption and
promotion of healthy diets. Novel strategies shall be utilized, as
appropriate, to ensure responsiveness in planning and implementation.
Surveillance systems and routine data collection activities, i.e. surveys,
shall be developed and implemented to generate relevant, timely, and
quality information regarding population-level consumption of sodium,
sugar, and fat, relevant knowledge, attitude, and behavioral indicators, and
other relevant health, social, economic, and/or environmental information.
Monitoring and evaluation mechanisms geared towards the continuous
assessment of the manufacturing, importation, and distribution of food shall
be developed and implemented to capture, record, and verify the impact of
the strategies outlined in this Order, and to provide recommendations for
improvement.
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National and local level implementers of the various strategies for the
reduction of population-level sodium, sugar, and fat, including food
producers, manufacturers, and food service establishments, as well as
relevant national and local government offices, partner institutions and
organizations, healthcare workers, and other public health advocates shall
be provided appropriate technical and/or financial assistance and capacity
development packages to enhance implementation of the strategies outlined
in this Order.
Complementary capacity development modules shall be developed with the
agriculture, education, social welfare and development, and trade and
industry sectors in order to highlight nutrition sensitive programming at the
national level.
6.
Recognition and Awards
a.
Local governments,
learning institutions, and partners that have
implemented interventions in alignment to and/or the achievement of the
objectives of this Order shall be formally recognized. Financial and/or
non-financial incentives shall be mobilized for this purpose.
b. The DOH HPB, through the IATWG-HD, shall develop mechanisms for
documentation and sharing of good practices across national and local
government offices, and institutions regarding
implementation of
interventions on the reduction of population-wide consumption of sodium,
sugar, and fat.
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35111.
ROLES AND RESPONSIBILITIES
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A. The DOH HPB shall:
1. Lead the development of the strategies and interventions outlined in this Order,
in coordination with relevant national and local government agencies and other
partner stakeholders;
Exercise multi sectoral policy coordination and enter into partnerships with
national and local government agencies, non-government and/or civil society
organizations, the academe, and other partner stakeholders for the
implementation of this Order;
Set intermediate and long-term targets for the monitoring and evaluation of
strategies outlined in this Order; and
Lead the information, education, and communication activities aimed at
increasing health literacy, and at improving knowledge, awareness and
practices regarding good dietary behaviors.
B. The DOH Disease Prevention and Control Bureau (DPCB) shall:
L.
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Lead in the development of policies, programs, implementation strategies,
research, and metrics/indicators on the management of nutrition-related disease
and conditions resulting from poor dietary behaviors;
Lead the
of practice guidelines and/or manual of
development
operations/procedures for nutrition-related disease and conditions;
Represent the DOH in technical working groups and committees on
nutrition-related disease and conditions; and
Coordinate and provide technical inputs in the development of PhilHealth
benefit packages for the management and treatment of nutrition-related
diseases and conditions across the life stages.
C. The DOH Health Emergency and Management Bureau (HEMB) shall:
1.
Ensure enforcement of relevant guidelines and regulations, specifically on
acceptance of donations of breastmilk substitutes in disaster and emergency
contexts pursuant to EO No. 51, s. 1986 and related issuances.
D. The Food and Drug
1.
Administration (FDA) shall:
Issue and enforce guidelines and regulations designed to reduce sodium, sugar,
and fat in the production of food establishments as provided in the specific
guidelines of this Order;
Determine the appropriate transitory period that shall not be more than two (2)
years from the effectivity of this AO in which the FDA will commence
regulation of processed food products that have complied with the guidelines
set.
E. The National Nutrition Council (NNC) Secretariat shall:
1.
Develop and issue policies through its governing board resolution, policy
statements, and advisories, supporting the strategies as provided in this
National Policy;
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3.
F.
414IX.
Collaborate with the DOH in the development and implementation of the
strategies and interventions outlined in this Order; and
Coordinate with the NNC Regional Offices for the implementation of the
strategies set in this Order.
The Centers for Health Development (CHDs) shall:
1.
Implement the communication plan at the regional level; and
2. Provide technical assistance to LGUs and advocate for the issuance of local
ordinances implementing strategies for salt reduction as provided for in this
National Policy.
REPEALING CLAUSE
415
416 All issuances inconsistent with the provisions of
Order are hereby revised, modified, or
417 rescinded accordingly. All other provisions of existing issuances that are not affected by this
this
418 order shall remain valid and in effect.
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X.
SEPARABILITY CLAUSE
422 If any provision of this Order is declared invalid, unenforceable, or unconstitutional, the
423 validity or enforceability of the remaining provisions shall not be affected, and this Order
424 shall be interpreted as if it did not contain the particular invalid, enforceable or
425 unconstitutional provision.
426
427XI.
EFFECTIVITY
428
429 This Order shall take effect fifteen (15) days
430 Gazette or in a newspaper of general circulation,
431 Administrative Register of the UP Law Center.
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433
following the publication in the Official
to be filed with the Office of the National
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TEODORO J. HERBOSA, MD
438
Secretary
439 Annex A.
440
Framework for Nutrition
Reduced premature morbidity and mortality from NCDs and other nutrition-related diseases
A
Reduced all forms of malnutrition
A
Increased consumption healthy diet
A
[
1
Health-Supportive Environments
Improved Health and Nutrition Literacy
Sustainable and Resiitent Food Systems
Active Spaces
Food Supply Chain
—
Nutrition-sensitive programs
Food
|
:
!
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442
443
Governance, Policies and Legislation, Partnerships, Capacity
Nutrition-specific
>
ms
Development,
Feed Consump
|
Financing, Service Delivery, Research
programs
Health and Nutrition Services
|
444 Annex B. References
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446
1.
ASEAN and UNICEF. 2024. Minimum standards and guidelines on actions to protect
children from the harmful impact of marketing of food and non-alcoholic beverages
447
in the ASEAN region. Jakarta; UNICEF.
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