A Vision For An Integrated Health And Agri-food Strategy For Canada

Previous chapters of this discussion paper have reviewed the various issues to consider when developing an integrated health and agri-food strategy: (1) the current context of the health and agriculture and agri-food sectors; (2) the current policy frameworks and strategies at the health, agriculture and agri-food interface; (3) the range of instruments that are being used, or could be used, to advance health and agri-food outcomes; and (4) the importance of using a systems perspective, including the important and increasing role of local and global value chains. Based on this analysis, this discussion paper proposes a vision for an integrated health and agri-food strategy for Canada.

A Vision for an Integrated Health and Agri-food Strategy for Canada

The vision proposed is of “improving the well-being of Canadians by providing safe, nutritious and accessible food that supports healthy eating, contains health care costs, and is promoted by innovative and sustainable agricultural, food and health sectors” (Figure 11). Under this vision, Canadians benefit from producing and consuming food that makes them healthier, while Canadian businesses in the agriculture and agri-food sector are better able to compete in local, national and global markets.

Figure 11. A vision for an integrated health and agri-food strategy for Canada.

The vision is supported by six pillars: safe food, nutritious food, accessible food, healthy eating, innovation, and sustainability. These six pillars were chosen because they represent the areas in which policies and initiatives currently exist of relevance to an integrated health and agri-food strategy. The key policies, initiatives, and considerations for each of the six pillars are briefly described in the following sections. It must be noted that these six pillars do not operate independently from each other.

This discussion paper proposes a set of “lever points for change” that run within and across these six pillars, in order to direct thinking and discussions with regards to the subsequent development of a strategy by leaders in the field. These lever points combine a selection of short- and long-term changes that can potentially lead to significant improvements at the interface of health, agriculture and agri-food. It must be noted that, thus far, neither the selection nor the suggested initiatives in each of the proposed lever points for change have been the object of a consensus-building process.

It is expected that these lever points for change would create a structure around which engagement and action by consumers, the private sector, civil society, public health, and agriculture and agri-food agencies at the local, provincial/territorial, national and global levels could be galvanized. This whole-of-society mobilization would translate the levers into a set of concrete and focused initiatives, leading to a more comprehensive and efficient innovation system. This innovation system would range from laboratory activities to the commercialization of products. It would include interventions at the farm level through to the retail level, and among health professionals and consumers. It would result in the development and promotion of foods that are safe, nutritious, economically and physically accessible, and consumed by all to ensure healthy eating. It is expected that concrete action around a limited set of levers will contribute to economic, social, and environmental sustainability in Canada and worldwide, and will translate into measurable health and economic outcomes. In the long term, these measures will reduce health care costs and improve economic performance for the agriculture and agri-food sector.

Food Safety

The Canadian context
Recent events have heightened consumer awareness of food safety as a health issue, and have increased the level of attention and discussion about the performance of the food safety system. Examples include recent high profile food recalls in North America, and the contamination of infant formula with melamine in China that caused kidney stones and illness for more than 53,000 children.¹⁰⁰ The public is now more aware that food safety depends on the reliability of the entire local and global agriculture and agri-food system, from inputs, production, and distribution to consumption, both domestically and globally.

In Canada, the Food and Consumer Safety Action Plan and the Growing Forward Framework provide the opportunity for governments, industry and consumers to work together to enhance food safety. A focus of the Food and Consumer Safety Action Plan is preventing issues over food safety from even arising. Government, industry, and consumers must therefore each understand the opportunities they have to ensure food safety and be prepared to act using the appropriate mix of mandatory and non-mandatory approaches. This also requires that the highest risks be addressed by all three actors along the value chain, whether that be on the farm, in processing plants, at distribution, retail, food services, or home. The Growing Forward Framework further commits Canada to: supporting food safety through improvements in on-farm food safety; enhancing safety of the food system to ensure greater market confidence in Canadian agricultural products; and, supporting scientific research to improve food safety systems.

The balance between government and industry action on food safety is changing over time. While food safety approaches are most often based on the use of legislation, regulations, and standards, industry is increasingly enhancing the government food safety programs through a variety of voluntary programs and use of private standards. Indeed, with the rise of powerful global value chains, the tremendous increase in the import and export of food and ingredients, and the increasing concentration in the distribution and retail sector, it is questionable whether government can remain the sole stakeholder in setting food safety policies and standards.

Two multi-stakeholder food safety coalitions are in place. First, the Canadian Supply Chain Food Safety Coalition¹⁰¹ was established in December 2000 with a mission “to facilitate the development and implementation of a national, coordinated approach to food safety.” Its members include national, provincial and local associations representing input from suppliers, farmers, processors, transporters, retailers and food service. Over the past year, this Coalition has been meeting to review progress in building food safety along the value chain and to develop a forward-looking strategy that articulates priorities for action in the next five years, as well as to define the roles of each stakeholder. Second, the Canadian Partnership for Consumer Food Safety Education¹⁰² was established in December 1997 by industry, consumer and government organizations “to coordinate and deliver food safety awareness programs aimed at the Consumer.” It includes more than 50 trade associations and government bodies.

Canada in the global context
All countries have a vested interest in ensuring that exporting countries have well functioning food safety systems. In many parts of the world, food safety systems of legislation, standards, and inspection are less well developed; the pace of development in the global agriculture and agri-food sector greatly exceeds the capacity of some countries to develop their food safety systems. The Codex Alimentarius Commission (CODEX)¹⁰³ works to develop international standards related to food safety. Furthermore, the WHO Global Strategy for Food Safety: Safer food for better health¹⁰⁴ sets out a framework for strengthening the food safety systems in all countries. The WHO, along with the Food and Agriculture Organization (FAO), work to provide capacity and programs to assist countries in developing strong food safety systems. While many countries and United Nations (UN) bodies provide capacity-building programming, private foundations such as Safe Supply of Affordable Food Everywhere are also now working to ensure food safety along the supply chain, and are formally exploring how to link these private initiatives to governmental efforts.

Given the increasingly complex nature of the value chains, effective food safety requires coordinated efforts by a variety of interdependent actors, encompassing the entire global value chain “from farm to fork.” It requires integrating multiple institutional spheres and actors – global, regional, national and local, and public and private – while cutting across the three key domains of primary agriculture, agri-food, and health. This process of creating effective food safety entails an important paradigm shift, since it forces the contemporary food safety system to evolve from a simple collection of risk-reducing guidelines, standards, and regulations to a complex web of public and private standards with multiple objectives.

The food safety system now encompasses multiple institutional spheres: regional, national, and international. It is also a mix of public (mandatory, voluntary) and private (collective, individual) standards. The EUREPGAP standards for fresh fruits and vegetables, for example, were initiated by 13 European retailers responding to the demands of Great Britain’s Food Safety Act.¹⁰⁵ Later, this program was expanded to GLOBALGAP, a private sector body that sets voluntary standards for the certification of agriculture and agri-food products around the globe. The GLOBALGAP standard, which is intended to serve as a practical manual for ‘good agricultural practice’ anywhere in the world, is primarily designed to inform consumers about proper food production on the farm. It involves minimizing detrimental environmental impacts of farming operations, reducing the use of chemical inputs, and ensuring a responsible approach to worker health and safety and animal welfare. A recent joint study by the Canadian Horticultural Council,¹⁰⁶ the Canadian Produce Marketing Association,¹⁰⁷ the Canadian Council of Grocery Distributors,¹⁰⁸ and the Canadian Federation of Independent Grocers¹⁰⁹ found that dozens of private and national standards are in place in many countries from which Canada imports fruits and vegetables. Further work to understand the variations between these emerging standards might improve the economic viability of this sector by achieving greater equivalence between the myriad of different national and private standards.

Nutritious Food

The Canadian Context
Canada has one of the highest consumption rates of trans fat in the world.¹¹⁰ It was found that if trans fat free vegetable oil was used in 80% of the shortening oil market in Canada and 50% of the salad oil market, it would reduce trans fat by almost 2g per person per day and result in potential health care savings of $1 billion per year, causing a 3% to 9% reduction in cardiovascular disease deaths (1,200 to 7,700 deaths).¹¹¹

In 2005, the multi-stakeholder Trans Fat Force¹¹² was created to provide the Minister of Health with recommendations on how to reduce trans fat in the Canadian food supply. The Task Force delivered these recommendations in June 2006. The federal government responded by implementing a program under which industry will continue to voluntarily reduce trans fat in its products. The government would report publicly on this progress for two years, after which it would evaluate whether significant progress had been made or whether regulations would be required. The Canadian agri-food sector (food processing) is well positioned to take action on trans fat (being world leaders in the development of new variants of oil seeds).

Strong multi-stakeholder support existed in Canada to take action to reduce trans fat because: (i) there was wide-spread knowledge about the negative health effects of over-consumption of trans fat, (ii) consumers were empowered through nutrition labelling to make choices about products based on levels of trans fat, and (iii) it provided industry with a consumer “demand” for more healthful, low in trans fat products, resulting in increased sales of such products.

Conversely, recent U.S. surveys by the Center for Science in the Public Interest (CSPI) indicate that little progress has occurred in reducing salt in processed foods in the United States, despite evidence of the negative health impact that salt has on health.¹¹³ Results from the 2004 Canadian Community Health Survey on Nutrition indicate that among people aged 19 to 70, over 85% of men and 60% of women had sodium intakes exceeding the recommended upper intake level.¹¹⁴ Furthermore, the recently released Canadian Heart Health Strategy and Action Plan as well as other healthy living strategies in Canada propose reducing salt as a key component in these strategies to reduce heart disease. There has been a call for government to act on this “market failure” through regulation. In 2007, the Minister of Health established a multi-stakeholder expert Sodium Working Group to work on developing a strategy to reduce salt in the Canadian food supply. The working group was tasked with providing its recommendations in 2009.¹¹⁵

Canada in the Global Context
Canada is committed to implementing the recommendations of the WHO Global Strategy on Diet, Physical Activity and Health. The Strategy recommends that populations and individuals:

• achieve energy balance and a healthy weight;
• limit dietary intake of free sugars;
• limit energy intake from total fats and shift consumption away from saturated fats to unsaturated fats and toward the elimination of trans fatty acids;
• increase consumption of fruits, vegetables and legumes, whole grains; nuts; and,
• limit salt (sodium) consumption from all sources.

Healthy Eating

In 2003, the first “diet-related disease risk reduction claims” were allowed in Canada. These types of claims provide Canadians for the first time with messages that some foods can reduce the risk of disease (e.g. “a diet rich in fruits and vegetables is linked to a lower rate of some cancer”). However, the process for approving these claims can be lengthy due to the current regulatory framework.¹¹⁶ In 2007, Health Canada held a cross-country consultation to discuss a “modernized approach to health claims.”¹¹⁷ Viewpoints are polarized between industry, which wishes to market a wider range of foods with health claims, and health organizations who wish to promote healthy diets generally rather than claims on specific products (especially on products considered by some to be “unhealthy”). Regardless of the outcome of this consultation, the approval process and its role in allowing innovative products onto the market remains an important issue.

In 2007, Canada released Eating Well with Canada’s Food Guide,¹¹⁸ which provides nutrition guidance to Canadians. The Food Guide, in combination with mandatory nutrition labelling on most foods, represents the cornerstone of nutrition information systems. There continues to be a need to invest in efforts to support Canadians in using the Nutrition Facts Panel and the Food Guide, as many Canadians are still not acting on this advice. The evidence is in the underconsumption of fruits and vegetables,¹¹⁹ and overconsumption of certain nutrients such as fats and salt.¹²⁰ The federal and provincial governments, as well as health organizations and industry, all have developed educational resources to assist in communicating nutrition information.

Some stakeholders believe government should limit “harmful” nutrients through regulations, whereas industry is a proponent of non-mandatory approaches and has already taken some action through health and wellness strategies. Consumers play an important role in driving market demand through their choice of food products. Nutrition labelling provides consumers with the ability to exercise this “choice,” although many consumers may not be well enough informed to exercise a true choice.

Canada in the Global Context
In Canada, the federal government has increasingly been urged to supplement current nutrition advice and education with new policies in the areas of restaurant labelling, advertising to children, and front-of-package labelling schemes (these schemes are in place in some other jurisdictions). Advertising to children is currently under discussion at the World Health Assembly, which will consider in 2010 whether to put global guidelines or other instruments in place.¹²¹ In Canada, through the Children’s Advertising Initiative,¹²² 17 food and beverage companies pledged to devote at least 50% of their television, radio, print and Internet advertising aimed to children under 12 years of age to the promotion of products that represent healthy dietary choices and/or include healthy lifestyle messages. Furthermore, the self-regulatory organization for advertising, the Advertising Standards of Canada (ASC), added an Interpretation Guideline¹²³ in 2004 to both of its codes related to food product advertising. The guideline was developed to help evaluate the appropriateness of food advertisements in the process of pre-clearance and in responding to complaints. In 2006, the ASC produced a Reference Guide¹²⁴ for advertising to children in Canada. Though led by industry, this is a private-public venture: the Government of Canada has delegated monitoring responsibility of the Broadcast Code to the ASC.

Another area under discussion at the global level is the use of “front of package” schemes. But it must be noted that countries supporting increased use of these schemes are countries that do not have mandatory nutrition labelling. In conclusion, Canada needs to carefully evaluate the evidence supporting the need for additional nutrition programs and policies, both domestically and at the global level.

Food Security

The Canadian context
Canada’s Action Plan for Food Security (1998) recognizes that food security exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food that meets their dietary needs and provides for an active and healthy life. Regular and consistent access to safe and nutritious food is essential for healthy eating. Some populations experience income-related challenges in accessing food, while others may have limited physical access to nutritious and culturally appropriate food (e.g., those living in remote communities).

Numerous Canadian studies have shown undeniable links between low/inadequate household income and food insecurity or insufficiency. As a household expense, food is a flexible budget item, whereas the costs of other basic necessities (e.g. housing, heat, electricity, etc.) are fixed or less negotiable. In 2004, more than 1.1 million households (9.2%) in Canada were food insecure at some point in the previous year as a result of financial challenges they faced in accessing adequate food.¹²⁵ Policy levers that change the social and economic environments (e.g. income supports, adequate employment, cost and availability of food) will have a significant impact on food access for many Canadians. Similarly, innovation in the agriculture and agri-food sectors may help reduce the cost and price differential between food of high nutritional quality and density and energy-dense, nutrient-poor food.

An analysis of food and nutrient intakes revealed that food insecurity is a marker of dietary compromises among adults and adolescents, and in some cases these compromises are strong enough to increase the risk of inadequate nutrient intakes.¹²⁶

Figure 12. Real commodity prices in local currency units. Reprinted with permission from Global Economic Prospects 2009, by The International Bank for Reconstruction and Development/The World Bank, 2009. Copyright 2008 by World Bank.

Canada in the global context
Global food prices have eased from their record high in the first part of 2008 (Figure 12).¹²⁷ Nevertheless, the World Bank estimates that higher food prices have increased the number of undernourished people by as many as 100 million from the 850 million considered undernourished prior to the 2008 food crisis.¹²⁸ The FAO estimates there are 820 million undernourished people in the developing countries alone.¹²⁹ In addition, many people in developing countries suffer from micronutrient malnutrition – also known as “hidden hunger” – which is caused by lack of sufficient micronutrients in the diet. These include vitamins and minerals such as vitamin A, zinc, and iron. Diets deficient in micronutrients are characterized by high intakes of staple food crops (such as maize, wheat and rice), but low consumption of foods rich in bioavailable micronutrients such as fruits, vegetables, and animal and fish products.

	Figure 13. World population (medium variant), 1950–2050. From the report Food Futures: Rethinking UK strategy, by Chatham House, 2009, pg 11. Copyright 2009 by Chatham House. Reprinted with Permission.

A report by the Chatham House¹³⁰ predicts that the demand for food will rise over the coming decades as the world population increases. By 2050, the world population is expected to reach 9.2 billion, with growth occurring primarily in the developing world (Figure 13).¹³¹ Growing affluence in developing countries has thus far increased the consumption of resource-intensive food. As a result, the World Bank projects that by 2030 the worldwide demand for food will rise by 50% and for meat by 85%.¹³² This increase in demand, in conjunction with climate change, energy security, water scarcity and competition for land, has led experts to speculate that food security will remain a challenge for decades to come.

Weaving Innovation across All Aspects of Healthy Eating

Canada has a strong base in R&D. Consequently, Canada could become established as a leader in the development and promotion of a large range of innovative agriculture and agri-food products, services, processing techniques, and new breeds of plants and animals, leading to better nutrition, safety, and accessibility of food. The Agricultural Policy Framework and the proposed Growing Forward Framework both have a strong emphasis on supporting innovation. Moreover, one of the seven priorities of the Agriculture and Agri-Food Canada (AAFC) Science and Innovation Strategy¹³³ is “enhancing human health and wellness through food, nutrition, and innovative products,” with a particular focus on functional foods (a key segment driving product and market development in the food industry). The number of new food and beverage products introduced each year in North America is over 20,000, with a total of over 120,000 introduced globally in 2008 (Figure 14).¹³⁴ This number reflects both consumer interests in new products as well as the ingenuity of the agriculture and agri-food sector in developing new products. An opportunity also exists to develop innovative products to meet changing consumer demands for a number of other food categories. For example, the number of organic and natural products introduced globally increased from about 3,000 to 8,000 between 2005 and 2008.¹³⁵

The key government policy tool for driving food innovation in Canada has been the use of R&D funding and tax credits. Canada’s Networks of Centres of Excellence are nationwide partnerships among universities, industry, government and non-profit organizations. The Advanced Foods and Materials Network (AFMNet), one of Canada’s Networks of Centres of Excellence, is an example of a nationwide partnership between universities, industry, government and non-profit organizations. AFMNet is composed of 39 universities, 35 industries, and 29 government departments. Governments also facilitate research, with Agriculture and Agri-Food Canada operating 19 research centers. Research clusters focusing on developing leading-edge products and technologies are found in almost every province. Furthermore, FOODTECH Canada is a network of leading food commercialization centers located coast-to-coast. Its primary goal is assisting industry in commercializing foods and bioactive ingredients.

The integrated health and agri-food strategy could be designed to augment these efforts in important ways, and help address the most critical challenges facing this industry. In a survey on such challenges, companies ranked the following issues as having a high or medium impact on innovation: lack of internally generated cash flow (42.2%); long gestation period of innovation (37.4%); insufficient flexibility in regulations or standards (37.3%); shortages of skilled workers (37.1%); and lack of marketing capacity (36.3%).¹³⁶

A Socially, Economically and Environmentally Sustainable Approach

Beyond agriculture and agri-food innovation, the integrated health and agri-food strategy would foster other business, social, and health innovations. The aim would be to ensure that the food supply and consumer demand for safe, nutritious, and accessible food translates into healthy eating for all, in a manner that is socially, economically, and environmentally sustainable. In Canada, “improving the environment and health of Canadians” is a key priority of the 2007 Speech from the Throne.¹³⁷ The link between health and environment in the area of food production is particularly acute vis-à-vis climate change, biofuels, and so on. Environment Canada’s Sustainable Development Strategy 2007-2009¹³⁸ includes goals that focus both on environmental quality (clean air, clean water, and reduced greenhouse gas emissions) and sustainable development (sustainable communities, sustainable development and use of natural resources, and governance for sustainable development). These three core components of sustainable development would guide the selection and operational form of all the lever points for change that will form the integrated health and agri-food strategy. The strategy would also reinforce the well-entrenched values and perceptions of Canadians concerning the linkages between health, agriculture, agri-food, and the environment.

Food For Thought: Lever Points for Change

Scaling up Traceability Systems for Food Safety Risk Management and Market Development Canada, like many other countries, continues to improve the food safety system in response to new and emerging food safety issues. The Growing Forward Framework and the Food and Consumer Safety Action Plan contain a series of programs related to food safety. These new programs are being designed with considerable engagement of industry, civil society and of governments at all levels.

Many countries are working to improve various elements of their food safety systems. The Canadian industry must innovate in order to keep pace and maintain its ability to export to these countries. Traceability is one such element. In Canada, work has begun to develop a national traceability system, but currently Quebec is the only province with a system. Federal and provincial ministers of agriculture recently announced their renewed commitment to developing a national traceability system for poultry and livestock.¹³⁹ The produce sector has also recently announced the development of an industry-led voluntary program for traceability of produce. Abroad, the EU has implemented mandatory traceability (Track and Trace)¹⁴⁰ for some high risk food products. In the Growing Forward Framework, Canada made a commitment to ensure rapid “return to business” following food safety incidents. Continued enhancement of traceability for meat and poultry is an important program element of this commitment. Such enhancement will also reassure trading partners that Canadian products meet export requirements.

Additional consideration could be made to supporting research, technology, and process developments in order to extend the traceability beyond its current Canadian focus on livestock. “Whole value chain traceability” is currently used to meet not only food safety requirements, but also to ensure consumer confidence in the labelling of other attributes, such as those saying a product is “hormone-free,” “antibiotic-free,” “grown local,” or a product of “fair trade.” This traceability represents a global trend that can provide niche markets for Canadian products. But this success depends on Canada’s ability to demonstrate that Canadian food products meet the desired attributes, whether they are organic, labelled “grown sustainably”, or labelled “antibiotic free.” Furthermore, based on our demonstrated strength in innovation with regards to livestock, dairy food products, and other food products, Canada has the opportunity to compete successfully in developing food ingredients and products that support specific consumer preferences in other jurisdictions.

In conclusion, Canada – with a strong infrastructure for information management – could have access to these emerging or niche markets through a combination of innovation and investment in whole value chain traceability.

A Whole-of-Society Systems Approach to Increasing the Supply and Demand of Fruit and Vegetables
Reducing the rates of obesity and micronutrient deficiencies and their health consequences through the consumption of 5 to 10 servings of fruits and vegetables per day would save the health care system significant amounts in direct and indirect costs. This lever point therefore calls for a whole-of-society effort to encourage the consumption of sufficient fruits and vegetables in order to support better health.

Figure 15. Fruit and vegetable: Retail. Source: USDA ERS FoodReviews Vol. 25, Issue 3. Converted to real dollars.

In Canada, efforts to increase consumer demand for fruits and vegetables must also work in concert with the horticultural sector, which has the ability to supply fruits and vegetables that meet consumer demand for price, quality, and convenience. Thus far, the core initiative to promote fruits and vegetables has been the 5 to 10 a day-For better health! campaign, a social marketing and school education program in place around the world that has been shown to effectively change individual behaviour in regards to fruit and vegetable consumption.¹⁴¹ In Canada, the program is lead by the Canadian Produce Marketing Association and is supported by the Heart and Stroke Foundation of Canada and the Canadian Cancer Society. A first component of this lever point for change would be to find novel ways to raise the financial resources needed to extend the program’s reach, particularly to the most vulnerable segment of the population.

While the supply of fruits and vegetables has remained relatively stable in recent decades, their relative price has increased (Figure 15).¹⁴² The integrated strategy would have to alleviate a good number of barriers in this regard, starting with the relative prices of fruits and vegetables in relation to snack and meal alternatives.

Canadian horticultural products are of high quality. Yet the Canadian horticulture industry is facing significant competition and other pressures compared to other growing economies, particularly the United States, its main market and competitor. These pressures are mainly due to the following factors: the rising costs of production, increased competition, a highly regulated marketplace (in food safety, environmental standards, tax policy, etc.), difficulties in storage and transportation, small-scale operations, a fragmented sector, a weak operating value chain, and limited product advertising.

Innovation in products and technologies can provide an additional competitive advantage, while meeting consumer demands for new, convenient products (e.g., salad in a bag, or pre-washed and pre-cut products, etc.). Other technological innovations could also include: investing in cooling equipment; new technologies for controlled atmospheric storage; the expanded use of irrigation to increase product consistency; and innovation that extends the marketing season through investments in proper pre-storage cooling, storage and varieties, etc. Innovation also has to occur at the strategic and organizational level of horticultural businesses in order to further support and promote R&D.

Clearly, innovations are needed at individual points along the fruits and vegetables value chain. In addition, the need exists for further systemic innovation if Canada hopes to reach the scale and speed of changes needed. The European Commission has recently set new benchmarks for a whole-system approach in the promotion of fruits and vegetables. It has recently revamped the Common Market Organization (CMO) to synergize with the Common Agricultural Policy measures and actions. This synergy, while not directly linked to the horticultural sector (such as rural development, trade and environment) may influence its development. The aim was to promote the supply and demand of fruits and vegetables by contributing to better economic and power distribution along the value chain. This reform introduced decoupled payments, which encourage the market-orientation of farmers while guaranteeing them a minimum income. It helps producers deal with short-term crises and encourages cooperation with non-EU country producers, while supporting inter-professional relations (thereby critically reshaping the potential for success of the initiative).¹⁴³ This novel policy compellingly illustrates the potential of how an integrated health and agri-food strategy could inspire the Canadian agenda.

Improving the Nutrient and Caloric Profile of the Supply and Demand for Processed Food
Even small changes in the nutrient and/or caloric profile of the supply and demand of processed foods can have a significant impact on the prevalence of chronic diseases. A recent simulation has shown that reducing salt by 400 mg/day, fat by 5 g/day, and caloric intake by 100 calories/day could save the United States health care system $2.3 billion, $2 billion, and $58 billion annually, respectively.¹⁴⁴

As mentioned earlier in this paper, recently the Canadian federal Minister of Health established a multi-stakeholder working group to develop a strategy to reduce salt in the Canadian food supply. Similarly, the European Union has recently set the reduction of salt in the food supply as a priority for action under its High Level Group on Nutrition and Physical Activity.¹⁴⁵ However, the United States government has not yet made salt reduction a priority; and while the U.S. Institute of Medicine is currently working on a set of recommendations for reducing salt in the food supply, they will not be binding on government or industry.¹⁴⁶

The agri-food sector (food processing) has invested considerable time and effort to find healthier oils, as a response to the need to reduce trans fat in the Canadian food supply. There are considerable lessons to be learned from this process, particularly in the context of reducing salt content. Reducing salt in the food supply will likely require a longer transition period as complex issues involving shelf life and food safety need to be addressed and consumer preferences for salt need to be gradually shifted. It will also require changing the food palate of the consumer. Research and development is required to develop new lower salt additives that maintain taste while ensuring food safety. Furthermore, the research and development challenge of the new reduced-salt additives will not be easily met by a country such as Canada, requiring a strategy to engage other countries to share in this technological exercise.

Other areas of the food supply could also benefit from shifts towards healthier nutrient profiles. Two areas of note are reducing sugar and increasing fibre, particularly whole grains. Recent studies¹⁴⁷ show that American consumers have increased their consumption of whole grains. This increase, however, is not due to an increased awareness, but due to the greater availability of processed foods containing whole grains. Companies are reformulating products as part of health and wellness strategies, and to meet the U.S. MyPyramid¹⁴⁸ recommendations for increased consumption of whole grains.

A variety of policy tools can be considered to stimulate demand for healthier foods. Building on the success of the anti-tobacco campaign, cities and countries around the world are increasingly considering imposing a tax on foods with poor nutritional profiles or a rebate/subsidy to promote foods with a healthy nutritional profile. These measures are targeting either categories of food or the nutrient profile of foods directly. For example, the New York Health Commissioner recently submitted a proposal for nutrient-profile based taxes,¹⁴⁹ after the previous attempt for food-category-based tax had been rejected at the State level. Regulations that control various business practices, such as shelf positioning, have also been adopted. Whether such moves will translate into significant health improvements has yet to be demonstrated. To date, the available evidence is based on hypothetical simulations, whose scientific value, in absence of actual data, is as good as the model’s assumptions. The careful empirical assessment of the health and economic impact of these new policy tools and approaches could be a first lever point for change, if this avenue is to be examined by leaders in the field.

Improving Nutrition and Streamlining Regulation in Functional, Nutraceuticals and Natural Health Foods
Many conventional foods are natural sources of functional ingredients that confer health benefits. These same functional ingredients can be added to other foods to enhance their nutrient profile, used in natural health supplements, or added as ingredients in animal feed. A compelling example is the addition of algae-, fish- or plant-derived omega-3 DHA and EPA to a range of food products (e.g. infant formula, eggs and meats). The addition of omega-3 DHA and EPA aids in the proper brain and eye development in babies and children (Table 3, Appendix 5).

Canada is well positioned to be a world leader in the area of functional foods, nutraceuticals, and natural health products. A recent study indicated that without gaining a greater market share, based on global growth, this sector had the potential to exceed market revenues from the $2.9 billion (2004 estimates) to $6 billion by 2010 and could contribute up to $12 billion annually.¹⁵⁰ However, challenges remain in achieving this market growth.

The government is responsible for ensuring that consumers are protected against unsafe functional foods and natural health products (FFNHP), and exercises this role through regulation. However, the government also plays an important role in ensuring that the regulatory environment supports strategic directions for the functional food and nutraceutical industry sector. Many reports¹⁵¹ have indicated that the absence of a modern and responsive regulatory environment in Canada impedes the growth of this sector. CAPI has undertaken a study on the development of a regulatory policy framework for the agriculture and agri-food sector. The study examined whether Canada has a modern and responsive integrated framework for the agri-food regulation, and proposes a path forward. One area of priority that the study addresses is the regulatory framework for health claims.

The agriculture and agri-food sector has recognized that new and innovative products may deliver opportunities to improve health while creating new markets. Yet, there are still many opportunities not being seized in the area of functional foods. For example, in Quebec, only 10% of products processed are “differentiated” products (products that have been transformed to provide added value).¹⁵² Yet, Quebec, as the centre of dairy production in Canada, has the potential to produce differentiated dairy products that could include added functionality. This is also true of other types of products, such as livestock and grain, for which the opportunity exists to develop new “niche markets.” Food processors should provide signals to researchers about trends in consumer attitudes and in food processing requirements for new functionality or ingredients. This assistance will enhance the translation of research into readily “marketable” products.

An integrated health and agri-food strategy would need to address broader issues, such as access to capital markets and human resources. The strategy for the FFNHP sector proposed by the Nutri-Net Canada reviews the opportunities and challenges of the sector as it builds a strategic plan to ensure sustainability and growth.¹⁵³

Fostering the Consumption of Canadian Foods through the Development and Promotion of a Canadian Diet
Many foods grown or produced in Canada contain functional ingredients that may have both a positive impact on health as well as benefits for the agriculture and agri-food sector were they consumed in larger amounts. However, most Canadians are generally not aware of the positive health benefits of these “Canadian” foods, beyond being aware of the overall healthfulness of some categories of foods such as fruits and vegetables and grains. Table 2 (Appendix 4) provides some examples of foods that are produced in abundance in Canada, such as flax, oats, barley, and lentils.

This lever point proposes to develop a Canadian diet that could reach the same prominence as other regional diets, such as the Mediterranean Diet, and contribute to positive health, sensorial, and socio-cultural outcomes from a uniquely Canadian perspective. The Canadian agriculture and agri-food sector has or is developing sector strategies (Soy 20/20,¹⁵⁴ Flax Canada 2015,¹⁵⁵ Canadian FFNHP Strategy proposed by the Nutri-Net Canada, Pulse Innovation Project: Growing Pulse Markets¹⁵⁶) which include initiatives to promote and enhance consumption of these Canadian agri-food products within the diet of Canadians.

This lever point builds on a similar initiative recently launched by the Nordea Bank in Scandinavia, a five-year study to develop a Nordic Diet and promote it in Denmark among families as well as in restaurants.¹⁵⁷ The New Nordic Diet (NND)¹⁵⁸ is inspired by the popularity of the new Nordic cuisine movement and the internationally recognized achievements of Nordic chefs. The diet will be built around local ingredients (such as cabbage, fish, wild native berries, oats and rye) and will be based on high intakes of inexpensive fish, such as herring, mackerel, salmon and trout. The NND will take a year and a half to develop, and includes a process whereby experts from nutrition, gastronomy, consumer organizations, sociology, and economics will meet to decide its fundamental elements. One hundred of the top Nordic chefs are being invited to contribute recipe ideas, which will then be tested on 1,000 families in the home. In addition, it is anticipated that the diet will be introduced through a school-based program.

The challenge of increasing consumption of Canadian foods lie in two areas: first, research must be conducted to substantiate the health benefits according to regulatory requirements in order to be able to make health claims; second, consumers need to be educated about these foods. For example, while the health claim “a healthy diet rich in a variety of vegetables and fruit and may reduce the risk of some types of cancer” has been permitted in Canada for five years, Canadians still do not consume enough of these foods.

Strategies are needed that will translate significant investments in research, development, and clinical research about health claims into marketing messages to Canadians that will lead them to demand, choose, and consume these Canadian food products. For example, research is ongoing to substantiate claims that oats and barley provide a source of beta glucans (a soluble fibre), which can contribute to diabetes prevention by lowering blood sugar levels. Increasing consumption of beta glucans, as with consumption of fruits and vegetables, will require a multi-stakeholder approach that includes education, marketing of products, and broadening health professional awareness of the potential benefits for patients with diabetes.

Promoting Technology, Business and Social Innovation and Entrepreneurship for Better Links between Small Farms and Local Food Businesses and Communities
In this discussion paper, Chapter 2 reveals that more than 60% of Canadian farms are small (under 400 acres) and more than 20% of them have a yearly farm income of less than $10,000. Small farms are one of the most challenging areas in the agriculture sector for productivity growth and profitability. A better balance between rural and urban development is also among the most critical agriculture, transportation, and consumption-related sustainability challenges facing Canada and the rest of the world.

A growing interest exists in “local food” initiatives, because they can simultaneously promote health and nutrition, economic prosperity of the local agriculture and agri-food sector, as well as local food security. Several cities have implemented Local Food Policies (e.g. Seattle,¹⁵⁹ Toronto,¹⁶⁰ etc.) and several provinces, most notably British Columbia, are weaving local food approaches into their agricultural strategies. A first step would be to conduct a systematic inventory of existing local food programs in terms of their health and economic outcomes, and to examine their transferability and scalability.

Most of the existing local food policies provide an opportunity for small local farmers to sell their goods in a variety of settings: at local food markets, through purchasing plans for local governmental institutions such as hospitals and schools, or through other public health programs (such as providing fruits and vegetables to local school children). In the context of the integrated health and agri-food strategy, in 2006 75% of farm incomes derived from fruits and vegetables were from farms with less than $100,000 income (compared to 10% for dairy farms) (Table A, Appendix 1). These local food initiatives could enhance the livelihood of small farmers who produce fruits and vegetables, while helping to address an important public health goal.

Furthermore, the promotion of local specialty products to restaurants provides an opportunity to drive local consumer demand of regional products, while increasing demand for these products in other parts of the world. Notably, the promotion of “local foods” can have benefits that go beyond direct health or economic impacts, particularly when the location of markets is carefully chosen to fill gaps in “food deserts” or when the local market schemes are linked to purchases by institutions (hospitals, schools, etc.) and to provide sustainable purchase arrangements.

The British Columbia Agriculture Plan: Growing a Healthy Future for B.C. Families includes strategies that provide additional ideas for an integrated health and agri-food strategy. The BC Plan aims to: to strengthen community food systems – from an infrastructure, logistic and education perspective – with farmer markets; support direct farm marketing, consumer- and community-supported farming, etc.; better link farm, school, and communities in joint efforts to improve childhood health; build capacity for small-farm and community-friendly food safety; assist farmers with human resources, entrepreneurships, and other business functions; preserve agricultural land; and, engage in the promotion of agriculture and agri-food products at the local and provincial levels. The Alberta food and health innovation framework¹⁶¹ proposes linking not only local farmers to local food companies, but also attracting local companies that could commercialize food ingredients and products with differentiated nutritional qualities.

Finally, this lever point could create linkages between developed and developing countries to share innovative approaches that will enhance the ability of small producers to participate in local and global value chains. For example, in India the Amul dairy cooperative of 2.2 million farmers (from 10,755 villages, with 3,000 collection centers all over India) built an innovative logistical infrastructure that allows women to come every day, morning and evening, to drop off a total of 6.4 million kg of milk.¹⁶² This cooperative now has revenues of $840 million with $30 million in annual exports. Similar value chain and market innovations could clearly benefit Canada’s small farms, and help contribute to health outcomes, not only in local communities but also at national and global levels.

Figure 16. Trends in global undernourishment. From the presentation “Committee on world food security,” October 2008, at the Assessment Of The World Food Security And Nutrition Situation, 34th session. Pg 2. Copyright 2008 by Food and Agriculture Organization of the United Nations. Reprinted with permission.

Innovation and Access to Bottom-of-Pyramid Markets for Safe, Low-Carbon Footprint, Affordable Agricultural and Processed Foods
As noted earlier, the world population is expected to increase to 9.2 billion by 2050, with this growth occurring primarily in the developing world (Figure 16).¹⁶³ The resulting increase in food demand, in conjunction with climate change, energy security, water scarcity, and competition for land suggests that food security will remain a challenge for decades to come. As a result of this issue, there has been increased interest in incorporating considerations of food affordability, food safety and nutritional quality – as well as low-carbon footprint food – into trade, food aid, and agricultural development goals. Three MWP global workshops¹⁶⁴ have been held on the topics of trade and diet and the need to incorporate healthy eating (food safety, nutritious food and food security) and environmental sustainability into agricultural and economic development programs. Most Canadian exports are destined for the United States. However, opportunities may exist to increase the global market share of Canadian agriculture and agri-food products that meet these criteria. These opportunities can be realized by promoting agriculture, agri-food, technological, and market innovations targeted to export or foreign direct investment in developing countries. C.K. Prahalad,¹⁶⁵ for instance, argues that the five billion people who are at the bottom of the pyramid present market opportunities that have yet to be tapped. Doing business in this sector, however, involves accounting for different value chain structures and dynamics. It also entails additional intermediaries whose motives, processes, and expectations must be understood and reconciled. As indicated in Figure 17,¹⁶⁶ these include, among others, philanthropy, civil society, multilateral societies, and aid agencies. Beyond product and process innovation, this lever point for change would also require significant market intelligence, business development, and capacity-building and training.

	Figure 17. Market development at the bottom of the pyramid in developing countries. From a presentation of C.K. Prahalad, 2008, at Global Convergence Building Workshop Commissioned by The Bill and Melinda Gates Foundation in Montreal. Adapted with permission.

For example, due to trends on global food needs, the Canadian pulse industry has captured market opportunities. Since the early 1990s, Canadian pulse production has grown from less than one million tonnes in 1991 to over 4.8 million tonnes in 2008, a four-fold increase, while exports have increased five-fold over the same time period, to 3.5 million tonnes. This increase has made Canada a global leader in the production of pulses, producing approximately 10% of the global pulse crop and accounting for nearly 40% of the global pulse trade.¹⁶⁷ The Canadian industry has been successful in capturing a dominant share of pulse markets around the world. For instance, Canada is the largest supplier of pulses in India, the world’s largest pulse market, providing nearly 50% of India’s total pulse import demand. Undernourishment remains a persistent issue in India, China, other Asian countries, and Africa (Figure 16). Canada can play a leading role in addressing these food security issues by building capacity to capture what has been called ‘bottom of pyramid’ markets in a profitable manner, promoting innovation to capture a larger share of this market.

Supporting Healthy Consumer Choices by Streamlining Nutrition and Health Information at Points of Purchase and Consumption In developing and implementing Canada’s Food Guide, as well as mandatory nutrition labelling, the government has taken great steps to provide consumers with core information about nutrition. Health, and nutrition in particular, may be the domain where consumers most often seek out and are provided with information. As a case in point, the Food Guide is widely used by Canadians, being the second most requested federal government document after the tax forms. The most recent version of the Food Guide has been translated into 10 different languages in addition to being produced in English and French.

Given that consumers often give little thought to their food purchasing habits,¹⁶⁸ placing salient information at points of purchase and consumption is likely to be highly influential. Beyond nutrition labelling, front-of-package (FOP) labelling approaches and shelf-level regimes have been put in place in Canada and in other jurisdictions. Based on variably defined nutritional and caloric criteria, manufacturers and supermarkets have developed numerous “better for you” programs (Smart Choices Program,¹⁶⁹ General Mills and Coca-Cola, Unilever USA; President’s Choice Blue Menu programs,¹⁷⁰ Loblaws; Guiding Stars Nutrition Program,¹⁷¹ Hannaford Brothers Company). Few formal evaluations have been conducted on the impact of such practices on consumer choices and sales performance. However, a measurable and significant shift does seem to have occurred in the nutritional and caloric value of products offered for sale and, maybe most critically, in the strategic focus given to R&D, product innovation, and market development.

Other countries have also established such systems. The U.K. has adopted a traffic light system that helps consumers make healthier food choices; it is used by a variety of manufacturers and retailers. The EU has been examining various approaches for nutrient profiling and front-of-package labelling. In the U.S., the Keystone Center recently led a group of leading food manufacturers and retailers through a process to develop a consensus on a unified FOP scheme, with corresponding simple logo identification across the country.¹⁷² It is too early to determine whether the Keystone logo will be adopted by industry, and whether it will have positive health outcomes. But it does appear that such a streamlining and simplifying approach is reducing consumer confusion.

In developing this lever point, consideration should first be given to launching a consensus-building process among organizations that have developed nutrition and health information systems in Canada. Unlike many other countries, Canada has both mandatory nutrition labelling and national nutrition guidelines. Therefore, it would be essential to evaluate whether an emerging FOP scheme could be adapted at the national level in order to generate significant health outcomes over and above those currently conferred by nutrition labelling and guidelines.

For restaurants and other food services, on-menu nutritional and caloric labelling has become a subject of considerable discussion. In the U.S., a few cities and states have implemented mandatory labelling of foods in restaurants. The cities include Portland, Philadelphia and New York, while California and Maine are at the proposal stage. Some early evaluation work from New York City indicates that consumers do act on the basis of the information. In a small survey of 270 New Yorkers, 86% of study participants said they were surprised by the caloric information, and 82% said it would induce them to change their consumption habits and choose lower-calorie alternatives.¹⁷³ However, the scale of these restaurant labelling initiatives is small, and so far only limited impact studies have been conducted. Broadening such initiatives – whether by mandatory or voluntary means – will require that employees of restaurants receive training in matters of nutritional and caloric information.

Fostering Policy and Practice Innovation in Education at Home, School and in Health Care Settings
The information-based strategies addressed under the preceding lever point are critical to an integrated strategy. Another essential area is education of young people. Education is a very powerful driver of eating behaviour, be it derived from parents, the school setting, or health professionals. Education acts not only through the information content it conveys but also, and possibly more potently, through the mindsets and social norms youth form and the emotional bonds they create to food, eating, and/or body weight. This lever point could focus on policy and practice innovation in a variety of educational settings to complement the current informational approaches, in particular for the most vulnerable segments of the population.

The effect of educational strategies on children can be immediate, and can have a lifelong impact on behaviour. It is generally acknowledged that parents and schools play an important role in moulding a child’s behaviour. These influences are essential to creating an environment that supports the development in children of a deep and long-lasting preference for nutritious food. Despite widespread awareness of the importance of parental and school-based influences, more innovative approaches are needed in both policies and practices.

Under this lever point, one particularly influential practice could be to increase the share of health resources devoted to education and persuasive communication, in order to promote healthy eating in health care settings. In fact, the Milken report, cited earlier in this paper, recommends the development of incentives and practice innovations to increase the share of health professional time devoted to these activities. It was reported earlier that the share of health care costs that is devoted to public health as a whole – which includes education and social marketing programs – is only 6%. Therefore, the health sector’s contribution to developing consumer demand for nutritious food could be greatly improved.

Fostering Policy and Practice Innovation in Social and Commercial Marketing
Turning to social and commercial marketing, the issue of marketing to children is occupying a central place in the public health arena of Canada as well as in other developed countries. This issue becomes more pressing as childhood obesity and the prevalence of overweight youths reaches epidemic proportion. Food advertisements make up the largest share of television marketing; typically, the food advertised is nutrient-poor and calorie-rich. The WHO Global Strategy on Diet, Physical Activity and Health states that messages that encourage unhealthy dietary practices should be discouraged, and positive, healthy messages encouraged.¹⁷⁴

A general consensus exists that limitations need to be placed on advertising to children. Yet there is no agreement on the level and modalities of such a restriction, or whether it should be through mandatory means or by self-regulation.

This lever point could augment existing initiatives, in order to better assess the single and combined effectiveness of various mandatory and non-mandatory policy tools related to advertising.Adopting additional measures needs to be carefully evaluated in Canada, where the portfolio of mandatory tools is already equipped with mandatory nutrition labelling and voluntary industry programs related to advertising. These policy and practice innovations also need to take into account the shared federal, provincial and municipal jurisdictions in this area.

Policy and practice innovation would also be a benefit in the area of social marketing (i.e., the use of carefully targeted persuasion practices that define marketing for public service purposes). It could be used to scale up various initiatives, such as Long Live Kids (LLK).¹⁷⁵ LLK was developed and is managed by the Concerned Children’s Advertisers (CCA), an organization of business leaders in food and media industry, and is in partnership with the civil society and public agencies in health and education (such as Boys and Girls Clubs of Canada, Dietitians of Canada, YMCA Canada, etc.). LLK developed commercial quality scientific and child-directed public service messages. These messages were aired across Canada in electronic and print media. LLK also developed an education program delivered to educators, parents, and community leaders to equip them with specific tools to combat obesity. Even though actual behavioural and health outcomes of this initiative have not been measured, advertisement effectiveness measures of this campaign, year-to-year, are many times superior to that of a standard social marketing campaign.¹⁷⁶ In addition, the educative material prepared has been integrated for some time now into provincial school curricula across Canada.

In conclusion, it is worth considering scaling up practice initiatives – through policy levers – that give stakeholders incentives to commit a larger share of their resources to this issue. Doing so could significantly improve the pool of resources devoted to promoting healthy eating.

previous section

next section