AMA Submission for Food Labelling Law and Policy Review
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AMA Submission for Food Labelling Law and Policy Review
The Australian Medical Association (AMA) is the peak medical organisation in
Australia. The AMA’s policies and public statements on a number of public health
issues, including obesity, food and nutrition are respected in the community and
sought by politicians and the media. Medical practitioners are highly trained
professionals, whose advice is often sought in relation to health behaviours,
including healthy eating.
The AMA agrees with the observation that a number of issues have arisen
around the Australian food regulation system, including concerns that consumers
have difficulties in understanding and using the information provided on food
labels. Eating a balanced diet is essential for good health. Eating inappropriately
results in poor health, and can be associated with serious chronic health
conditions. Food provides our bodies with the energy, protein, essential fats,
vitamins and minerals to live, grow and function properly. According to the
National Health and Medical Research Council the major causes of ill health in
which diet and nutrition plays an important role include coronary heart disease,
stroke, hypertension, atherosclerosis, obesity, some forms of cancer, Type 2
diabetes, osteoporosis, dental caries, gall bladder disease, dementia and
nutritional anemias.
i Obesity,
in particular, is a major public health problem. In 2008, obesity became
a National Health Priority Area.ii More than half of Australian adults are
overweight or obese,iii and it has recently been suggested that obesity has
overtaken smoking as the leading cause of premature death and illness in
Australia.iv The AMA believes that a whole of society approach is essential to
addressing obesity. This will require significant commitment from, and
cooperation between, Governments, non- Government organisations, the food
industry, the media and health professionals.v The appropriate regulation of food
labelling is vital to maintaining the health of Australians, and is essential in
Australia’s fight against obesity. The AMA believes that food labelling which is
simple and informative is key to making it easier for people to make healthy
choices about the types and amounts of foods and beverages they consume.
The AMA considers that there are certain respects in which food labelling laws
and policy in Australia can be improved in order to maintain public health and
safety.
The Objectives of Food Regulation
Food regulation already plays a significant role in protecting the health of the
public. This includes ensuring that food is safe for consumption, approving new
food ingredients, products and formulations, as well setting requirements such as
those around country of origin labelling and the display of the Nutrition
Information Panel (NIP). Given this significant role, the underlying principles and
objectives governing Australia’s system of food regulation must be the right ones,
and there must be clarity in how those principles are defined and what they imply.
The Food Standards Australia and New Zealand Act 1991 sets out the primary
objectives of food regulation in Australia as (in descending order of priority):
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

The protection of public health and safety; and
The provision of adequate information relating to food to enable consumers to
make informed choices, and
The prevention of misleading and deceptive conduct.vi
The AMA considers that the first objective is not sufficiently well defined. The
clause ‘the protection of public health and safety’ can be understood in a narrow
sense, to exclude any requirement to promote good health among the public.
This narrow interpretation is the one often endorsed by Australian government
food regulation agencies, and it can act to restrict the impact of food regulation in
serving important health goals. The UK’s Food Standards Agency provides an
example where public health promotion in relation to food and nutrition is an
objective, as well as the protection of public safety. Some may argue that
promoting the public health is too strong an interpretation of the objective of
‘protecting the public health’. Even if that were the case, this objective does, at
the very least, imply a goal of seeking to maintain an acceptable (minimum)
standard of health among the public – maintaining it in the sense of protecting
against unacceptable health outcomes that may result from inappropriately
regulated food and beverages. What, other than an acceptable (minimum)
standard of public health, is required to be protected? It is against this
interpretation that the effectiveness of the Australian food regulation system, and
food labelling laws and policy in particular, should be evaluated. As indicated, the
levels of obesity and chronic disease in the population are very high, and
increasing – in part due to inappropriate consumption levels of inappropriate
foods and beverages. In other words, an acceptable minimum standard of health
is not being maintained for a significant proportion of the population. While food
labelling is by no means the sole factor underlying people’s consumption
behaviour, it is a significant factor in the choices they make. The AMA’s view is
that food labelling laws and policy can be improved to better serve the primary
objectives of food regulation in Australia, properly understood. The following
indicates key ways in which improvements can be made.
To start with, the AMA considers that government agencies and food regulators
must be completely faithful to the primary objectives of food regulation (and
labelling policy). This means that significant public health considerations should
always outweigh the administrative and profit-related concerns of food and
beverage manufacturers and retailers. Further, when the evidence is not yet fully
established about impacts of products on human health, the Precautionary
Principle should be applied by government agencies and regulators when making
decisions.
Food labelling
Many consumers have difficulties in understanding and using the information
provided on food labels. While standardised food labelling in the form of the NIP
is legislated in Australia,vii this information is not easy to decipher. Consumers
may focus on one aspect of the information provided in the NIP, such as sugar or
fat content, with limited understanding of other information such as total energy,
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sodium and serving size, which are also important in terms of healthy food
choices. In addition, health claims on foods may increase the complexity of
decision making, particularly in those instances where the evidence is not well
established. The AMA considers that there is a need for more effective, and user
friendly, food labelling to be implemented in Australia. Efforts to improve food
labelling must coincide with public education efforts that support increased
nutrition literacy, such as the efforts undertaken by the UK Food Standards
Agency. In terms of specific improvements, the AMA recognises the evidence
that trans fatty acids pose a considerable risk to cardiovascular health, even
when consumed at low levels viii,ix and has called for food labels to include
information about added trans fatty acids. This should be part of a broader
initiative to phase out the addition of trans fatty acids altogether. Some may
argue that this is an unreasonable expectation that would unfairly impact on food
producers. However the phasing out of added trans fatty acids in New York City
appears to have been successful, despite its early stage. Denmark has also
enacted legislation to eliminate industrially produced trans fatty acids. This has
also been recommended in the UK.x There should also be full labelling of
genetically modified foods and the current system of labeling for genetically
modified foods should include reference to the method of production. Ingredients
and foods altered through nanotechnology should be labelled in a way that is
consistent with the requirements of genetically modified foods. The AMA has also
called for an alert system whereby medical practitioners can notify authorities if
they believe a reaction may have occurred to the consumption of a genetically
modified or other novel food.
Front of Pack Labelling
With advances in preventive medicine and the management of chronic diseases,
many Australians can expect to live longer lives. However, poor nutritional habits
and being overweight or obese can contribute to or exacerbate many health
conditions, and decrease an individual’s quality, if not length of life. A food
labelling scheme that is clear and comprehensible can be effective in enabling
consumers to make informed purchasing decisions and influence consumer
behaviour, as well as providing incentives for food companies to improve the
nutritional composition of products.xi
The AMA considers that a simple, uniform front of pack (FOP) labelling system is
an essential part of efforts to improve food labelling in Australia. Research shows
that consumers make choices on the basis of nutritional information, and prefer
‘at a glance’ information.xii Evidence suggests that labelling formats such as the
‘traffic light’ system can influence consumers’ choices towards more healthy
products.xiii A recent independent evaluation of FOP labelling commissioned by
the UK Food Standard’s Agency concluded that:
o A single FOP approach would be most helpful to shoppers;
o The strongest FOP label combines: the words high, medium and low; traffic
light colours; percentage of guideline daily amount; levels of nutrients in a portion
of the product;
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o FOP labels are used particularly when: shopping for children; comparing
different products; shoppers have a particular health concern; shoppers are
watching their weight;
o There is generally a high level of understanding of FOP labels, even among
those who don’t tend to use them, and raising awareness of a single approach
could encourage more people to use FOP labels.
While there no evidence specific to Australia, the above conclusions are still
relevant to the Australian context, and should inform the development of a front of
pack labelling system for Australia. The Percentage Daily Intake approach, which
is prevalent in Australia, makes broad assumptions about an individual’s energy
requirements (based on that of an adult male). Taken on its own, this method
may misinform consumers, including women, children, and those who are
overweight or sedentary.
Alcohol labelling
Alcohol is a commonly used beverage (and hence a food product), but it is also a
mind altering substance with potentially harmful effects. Given this, the AMA has
consistently supported calls for warning labels to be included on alcohol products
to ensure that consumers are alerted to the potential consequences of excessive
alcohol consumption. It is possible that consumers, especially those who are, or
should be, weight conscious, may also benefit from alcohol labels including
reference to the energy content of alcoholic beverages. It has been suggested
that young women in particular may be less inclined to participate in binge
drinking episodes if this type of information was displayed. A rudimentary study of
Australian university students, aged 17-25, suggested that more than three
quarters of participants wanted to see ingredient and nutrition information
displayed on alcohol packaging.xiv
Allergen Labelling
In 2002, the Food Standards Code was amended to mandate the labelling of
common food allergens to ensure that those who suffer from food allergies are
appropriately informed about the content of the food they consumed. While the
AMA appreciates the difficulties in establishing a common threshold of dose that
may trigger an allergic or anaphylactic reaction, there is growing concern that
the wording on labels - ‘May contain traces of …’ is used by the food industry as
a blanket disclaimer, resulting in increasingly limited food choices for those with
food allergies.xv It may be timely to consider an alternative food allergy labelling
system. The Australasian Society of Clinical Immunologists and Anaphylaxis
Australia are well placed to support such an activity.
The Role of Government
In many areas of public health, tensions sometimes arise between protecting
public health, and allowing industry to be innovative and profitable. A specific
example of this tension is the issue of television junk food advertising during
children’s viewing hours. The food manufacturing and retailing sector advertise in
this way to make a profit, whereas the AMA considers this should be banned
because it is not developmentally appropriate and contributes to poor health
outcomes.
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As indicated, health considerations should be the primary factor in food
regulation. There is reason to think that a self-regulatory approach to food
labelling on the part of industry may not accord health outcomes this primary
importance. For example, a number of food producers have voluntarily agreed to
cease advertising of junk food to children via television. However some
organizations persist, and others have specifically pursued other advertising
mediums such as the internet. The AMA considers that a co-regulatory approach
may be appropriate in the first instance, which includes representatives from the
food industry, public health advocates, consumers and governments. If this
approach fails it may be necessary to increase the Government’s regulatory role
in these areas.
Complimentary Medicines and Foods
The AMA supports the suggestion that concerns arise around the demarcation
between substances that could be regarded as foods or complimentary
medicines and the separate regulatory systems that apply to these. The range of
functional or therapeutic foods are likely to increase in the future, so it is timely for
this matter to be considered. The AMA believes that the Government has a clear
role in registering and monitoring such foods. Dialogue between the Therapeutic
Goods Agency and FSANZ needs to be supported so that these products are
appropriately regulated (and investigated where necessary) to ensure that
consumers are not placed at risk or misled.
i National
Health and Medical Research Council. Nutrition. Available from:
http://www.nhmrc.gov.au/your_health/healthy/nutrition/index.htm#imp
ii Australian Health Minsters’ Conference Communiqué. 18 April 2008. Available from:
http://www.ahmac.gov.au/cms_documents/2008%20%20April%2018%20AHMC%20Delivering%20Results%20Communique(1).doc
iii Australian Bureau of Statistics. Australian Society Trends 2007, Overweight and Obesity. 2007.
ABC Cat. No. 4101.0
Available from:
http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/2586A287F0EE3016CA25732F001C96B
F/$File/41020_Overw
eight%20and%20obesity_2007.pdf
iv Hoad V, Somerford P & Katzenellenbogen J. High body mass overtakes tobacco as the leading
independent risk factor
contributing to disease burden in Western Australia. Aus & NZ J of Pub Health. 2010 vol 34 no. 2
pp 214-5
v AMA Position Statement on Obesity – 2008 amended 2010. Available from:
http://www.ama.com.au/node/3033
vi Food Standards Australia New Zealand Act 1991. Act No 118 of 1991 as amended. Available
from:
http://www.comlaw.gov.au/ComLaw/Legislation/ActCompilation1.nsf/current/bytitle/EB9899847AA
F558CCA25731C0
018C333?OpenDocument&mostrecent=1
vii Australia and New Zealand Food Standards Code. 2010 Incorporating Amendment. Available
from:
http://www.foodstandards.gov.au/foodstandards/foodstandardscode/
viii Mozaffarian D, Katan MB, Alberto A et al. Trans Fatty Acids and Cardiovascular Disease. 2006
NEJM 354 (15):
1601- 1611
ix Mozaffarian D, Clarke R. Quantitative effects on cardiovascular risk factors and coronary heart
disease risk of
replacing partially hydrogenated vegetable oils with other fats and oils. Eur J Clin Nutr 2009. Vol
63 (suppl 2): S22-33
x As part of the UK Faculty of Public Health and Royal Society for Public Health’s 12 step
manifesto to better public
health, as referenced in: Mozaffarian D & Stampfer MJ. Removing industrial trans fat from foods.
Editorial. 2010. BMJ;
340:c1826
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xi Australia:
the healthiest country by 2020. Technical Report No 1 Obesity in Australia: a need for
urgent action. 2009.
Commonwealth of Australia. Available from:
http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/tech-obesity-toc
xii UK Food Standards Agency, 2007, Front of Pack Signpost Labelling – Exploratory Research,
Report COI 280040
1095 JS April 2007
xiii Gerda I J. et al. Front of pack nutrition labelling: testing effectiveness of different nutrition
labelling formats front-ofpack
in four European countries. 2008 Apettite. Vol 50 pp57-70
xiv Kyrpi K, McManus A, Howat P et al. Ingredient and nutrition information labelling of alcoholic
beverages: do
consumers want it? (letter) Med J Aust. 2007 Vol 187 No 11/12. pp:669. Available from:
http://www.mja.com.au/public/issues/187_11_031207/kyp10914_fm.html
xv Said M, Weiner J. “May contain traces of…”: hidden food allergens in Australia. [Editorial] Med J
Aust. 2004 Vol
181 No 4 pp:183-4 Available from:
http://www.mja.com.au/public/issues/181_04_160804/sai10422_fm.html