Make the rules for nutrition security

India’s epic regulation to prevent more than 800 million people from starvation on the one hand, via the national food security act, and a proposal to impose as high as 28% sin tax on tobacco, alcohol and other unhealthy items, on the other, needs huge applause.

Even the recent shutting down of multiple outlets, in excess of 160, of a junk food corporate, although over alleged financial disputes, is a brilliant move in the arena of public health and nutrition regulation. Although late, these regulatory and policy endeavours may go a long way in improving India’s currently abysmal public health and nutrition scenario.

More than two decades old now, the national nutrition policy (1993) failed to provide any substantial leadership or results in tackling the multiple forms of malnutrition in the country. We only saw an almost stagnant undernutrition rate during this time, along with a rise in the obesity burden and pervasive, multiple micronutrient deficiencies.

Well-intended, evidence-based regulation and its effective implementation will lead to sustainable gains in public health by reducing the morbidity and mortality burden, empowering consumers to make informed choices, keeping the industry’s misleading conduct and dubious practices in check, and translating into economic benefits.

Consider smoking, for example. No one stopped when they were “told” that smoking may cause cancer. But taxing cigaret­tes, banning advertising, setting age limits for selling tobacco products and restricting smoking in public places made it both an imperative and easier for many people to stop, and also discouraged new ones from taking to the habit; obesity and chronic diseases have dropped after enforcement of strong policies (restrictions on trans-fats in Denmark; taxation of carbonated and sugar-sweetened beverages; mandatory front-of-pack labelling; workplace interventions, physical activity promotion, breastfeeding promotion).

Industry endorses self-regulation but spends billions of dollars on misleading advertising in the name of innovation and creative independence, which encourages us to overeat unhealthy foods. They portray government regulation as a feature of a nanny state that deprives people of the freedom to exercise their will.

We all know that the meal with free toy becomes the default choice of the kids and thus their parents’. Advertisements blatantly showcase that consumption of “cool” — read ultra-processed foods, high in sugar, salt and fats) foods and drinks will lead to better social acceptability. Is this not arm-twisting using marketing and advertising gimmicks? Is this not leading people to make unhealthy choices?

Economists say that just obesity and its related consequences can cost us $190 billion annually. Modelling estimates suggest that interventions as simple as mandatory food labelling may reduce obesity prevalence by 2.5-6.5%. About 15 million DALYs (disability-adjusted life year, a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death) per annum can be averted by simple policy interventions. Research also shows that several simple public health and nutrition (PHN) interventions can be clubbed for a cost-effective response.

Threats and possibilities

Some challenges that merit our attention when we think of PHN regulation: a) the regulation’s coverage, format, who will be excluded and why? b) Synching advertising guidelines with proposed regulation (for example, banning junk food advertisements and their sale near or in children’s spaces); c) how will we include or bring in restaurants, small joints, takeaways, unorganised sector as stakeholders? d) Collaborations (vendor/small manufacturers associations, civil society, licences); e) Implementation and surveillance.

Some strategies that may enhance the impact of regulation may include strengthening regulatory agencies like the Food Safety and Standards Authority of India; state-wise compulsory participation, empowering nutrition research institutions which may provide high quality eviden­ce to influence what works and what doesn’t in local context, constituting independent unbiased group of experts and advisers to collate evidence and present to decision-makers, partnerships among stakeholders, reducing corruption, consumer awareness camps, short-term licensing and renewal based on compliance with set criteria or guidelines for food safety, transparency and accountability checks, time-based outcome analysis results, setting up robust and sustainable surveillance system.

Above all, efforts to make all involved bodies work in-sync with opportunities to constructively criticise and discuss issues. In fact, it will be good to invest in a baseline (pre-regulatory landscape) and then make periodic changes in key health outcomes. The states can standardise these measures and the Centre can collate these as a part of standardised surveillance system to monitor PHN.

We must collectively advance from mere feeding to nurturing. Let us broaden our focus to care about public health and nutrition security than mere food security. As the legendary German writer and statesman Johann Wolfgang von Goethe said, “Knowing is not enough, we must apply. Willing is not enough, we must do.”

(The writer is Associate Professor, Public Health Foundation of India)