ARCHIVED - Defining "Healthy" and "Unhealthy" Foods: An International Review (2009) - Executive Summary

Highlights of the Report

This report is a summary of a paper that was commissioned by Health Canada to provide an overview of what governments around the world have done so far to define "healthy" and "unhealthy" foods in policies and programs to promote healthy eating as well as definitions developed by the private sector, non-government organizations (NGOs), and academic researchers.

The report looks at the application of these definitions in 6 core policy areas:

1. foods with added nutrition/health qualities;
2. food labelling;
3. food product development;
4. food in public settings;
5. food advertising and promotion; and
6. food programs for vulnerable households.

The review identified 19 countries where governments have developed definitions for "healthy" and/or "unhealthy" foods. Another 3 countries and the European Commission have developed draft definitions (making a total of 23 countries). One further country has developed a draft law which provides a framework for making such a definition (making a total of 24). The private sector, NGOs and researchers have also developed several definitions.

This review indicates that the question - at least from a government standpoint - seems to be not so much "Is it healthy?" but "Who is it 'healthy' for?" and "In what context does a food become 'unhealthy'?".

Full Executive Summary

• Introduction
• Methodology
• Key Findings
• Discussion
• Concluding Notes

Introduction

Policy makers engaged in efforts to promote healthy eating are continually seeking ways to promote foods that contribute to healthy eating patterns. This brings with it the need for having to define "healthy" or "healthier" foods for particular policy applications. For example, what foods should be able to carry health claims, what foods should be marketed to children, and what foods should be served in schools?

Methodology

An international literature scan was carried out to identify the governments around the world with policies in any of the six selected core policy areas. The second stage involved identifying whether these policies included some sort of definition for "healthy" and/or "unhealthy." Government officials were also contacted to identify or confirm details of the definitions where necessary. The third stage involved identifying definitions developed by the private sector and NGOs. This search was based on existing reviews and a search on industry websites. The fourth stage involved identifying definitions developed by researchers - usually nutrient profiling or scoring methods - and published in the academic literature.

Key Findings

In total, the number of government definitions developed or in draft for the direct purpose of application to a specific policy amounts to 37 in 24 countries, with one country (Chile) having set a draft framework from which to develop their definition. In addition, official bodies in two countries - France and the Netherlands - have developed nutrient profiling models, but these have not actually been applied to any policy.

The most common application of government-led definitions is for foods served in schools. Counting both the developed and draft definitions, 17 governments have developed some form of definition of what is "healthy" and "unhealthy" school food. The second most common policy application was for managing food regulations, specifically for disease risk reduction claims. Governments have also developed definitions of "healthier" and "less healthy" for the purpose of point-of-purchase labelling schemes in four countries. Three of these countries use the same scheme (Denmark, Norway, and Sweden).

In the United States, food manufacturers and retailers have developed a plethora of point-of-purchase symbols. Non-profit organizations and researchers have also developed point-of-purchase schemes for application by the food industry, and in six countries, heart and diabetes associations have developed such symbols.

With regard to advertising to children, one government - the UK - has developed a definition of "healthy" and "unhealthy" for the express purpose of advertising to children, though it does not cover other forms of marketing. In two other countries, self-regulatory initiatives to restrict advertising to children use a definition of "healthy" borrowed from a government definition developed for other applications (schools and health claims in the case of New Zealand; a point-of-purchase scheme in the case of Denmark). In addition, food companies have developed their own definitions of what should and should not be advertised to children in voluntary "pledge" schemes developed in six markets: the European Union, Australia, Brazil, South Africa, Thailand and the United States (as well as Canada). These pledges are now being expanded into other markets.

National governments have not developed a definition of "healthy" and "unhealthy" for the purpose of directing reformulation by the food industry in areas such as food fortification or functional foods. But two companies - Nestle and Unilever - were identified that have developed nutrient profiling systems in part to assist their product development and reformulation.

The only application of the definition of "healthy" for food programs for vulnerable households was a rather limited application in the United States - the WIC program (the Special Supplemental Nutrition Program for Women, Infants and Children). In the United States, too, food banks (which fall into the category of NGOs) have been struggling with this definition for the purpose of their donation programs.

Discussion

Governments around the world have developed definitions of "healthy" or "healthier" foods and "unhealthy" or "less healthy" foods to encourage their populations to adopt healthier eating patterns.

The food industry has also engaged in developing their own definitions of "better for you" foods as part of their health and wellness initiatives, as have health-related NGOs. The research community has played a role by developing their own definitions, and by contributing to government- and industry-definitions as part of advisory groups, or, on occasion, by designing the system for the definition itself. Though all these stakeholders clearly have a common interest in encouraging consumers to eat more of the foods defined as "healthier," key characteristics of the development of the definition of "healthy" and "unhealthy" is its controversial nature and the diversity of the models developed.

Overall, these different systems result in different foods being classified as "healthy" or "unhealthy" and a more systematic analysis would be needed to examine the significance of these differences.

Concluding Notes

The ranking or classification of foods on the basis of their contribution to health is a controversial issue. This review indicates that the question - at least from a government standpoint - seems to be not so much "Is it healthy?" but "Who is it 'healthy' for?" and "In what context does a food become 'unhealthy'?". In other words, in making definitions, governments are not saying that any food is "healthy" or "unhealthy," but that they can become "healthy" or "unhealthy" in particular contexts, and for particular people.

One way forward, then, might be to reframe the debate from one of defining what is meant by "healthy" and "unhealthy" foods overall, to defining when, where and for whom foods become "healthy" or "unhealthy." In this framework, there is no such thing as a "good" or "bad" food, but there are ways of presenting and providing those foods that are more likely to lead to healthy or unhealthy diets.

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