New report on front-of-pack nutrition labelling identifies what works better for consumers

Poor diet is the leading cause of mortality and morbidity across the WHO European Region, including contributing to obesity, type 2 diabetes mellitus, cardiovascular disease and some types of cancer. Nutrition labelling, one of the key policy tools that can be leveraged to support healthy diets, is the focus of a newly released Health Evidence Network (HEN) synthesis report showcasing good examples and inspiring countries working actively on food policies to promote healthy diets.

When nutrition labelling is readily noticeable, understandable and compelling, it has the potential to stimulate consumers to make informed healthier food choices and to drive reformulation of products, with manufacturers seeking to avoid disclosure of unfavourable nutrient content.

Nutrition labels that are presented on the front of food packages and that use interpretational aides, such as interpretative words, colours and symbols, are more likely to be used and understood by consumers. Consequently, the WHO European Food and Nutrition Action Plan 2015–2020 identifies the introduction of interpretative, consumer-friendly labelling on the front of packages as a priority policy issue.

Surveys undertaken by WHO/Europe show that the majority of countries in the Region have some form of front-of-pack labelling (FOPL), although fewer countries have interpretive systems which provide judgements about the relative healthfulness of foods.

The new HEN report, which summarizes information on the development and implementation of interpretive FOPL policies across the Region, was commissioned and developed jointly by the Division of Noncommunicable Diseases and Promoting Health through the Life-course, including its geographically dispersed office based in Moscow, and the Division of Information, Evidence, Research and Innovation.

Different approaches; different objectives

Fifteen countries in the Region were identified as having a government-endorsed policy on interpretive FOPL. In 13 of these countries, endorsement logos had been adopted. These logos serve to signpost better-for-you choices, but provide no direct information to indicate if a product contains too much of a nutrient or ingredient that should be limited in the diet, for instance saturated fat, salt or free sugars.

Governments in France, Israel and the United Kingdom had endorsed FOPL policies that provided directive information about high nutrient content (i.e. a negative evaluation relating to high fat, salt or sugar content).

The HEN report also identified common steps involved in policy development, including establishing FOPL as an important nutrition policy pillar, engaging stakeholders and the public, and collecting formative evidence on which to base the labelling system. In all but one country, FOPL policies have been implemented under voluntary arrangements, with variable penetration of the labels into the marketplace.

However, existing policies across the Region vary in the extent that they:

• apply only to products that achieve a set standard/threshold or that apply across all products;
• provide information on individual nutrients or summary information on products overall;
• provide evaluative judgements about only product healthfulness or information about relative or absolute unhealthfulness of products.

Implications for policy development

Based on the evidence synthesized in the report, a number of considerations were identified for the adoption or review of FOPL policies at the national or regional level, to ensure that policies achieve the population nutrition aims of FOPL.

These included:

• applying a single FOPL system to aid consumer use and understanding of the label;
• utilizing a system of interpretive FOPL that allows for negative evaluative judgements about high nutritional content (i.e. an indicator of high fat, salt or sugar content);
• opting for government-led policy development rather than a commercially based system, as consumers perceive the latter as less credible;
• conducting stakeholder engagement and formative research to ensure that the right policy is chosen for the population;
• exploring ways to overcome issues with implementation through guidance documents, public education and, possibly, mandatory implementation;
• creating a formal and comprehensive policy monitoring and evaluation programme.