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 “The Business of malnutrition”  breaking down trade rules to profit from the poor

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Codex Nutrition Committee: Bad Soden, Frankfurt, Germany.  

12-18th November 2011

A dozen developing countries and health campaigners attending the Nutrition Meeting of Codex, the UN body that sets international food standards,  (1) achieved partial success in their call for strict controls on the marketing to be included in Guidelines (2) on a range of processed fortified products for babies that were never clearly defined. The objective was to provide nutrients which are “either lacking or are present in insufficient quantities,”  with the clear aim of targeting all those 'at risk' of malnutrition.

The countries, Brazil, Nigeria, Chile, Zimbabwe, Botswana, Gambia, Togo, Cameroon, Nicaragua, Costa Rica, South Africa and Bolivia,  fearing that uncontrolled marketing would undermine breastfeeding (3), increase family poverty and create dependence on products that are expensive and often unnecessary, called for several key World Health Assembly Resolutions to be mentioned in the guidelines.  (4). The United States and the European Union  initially opposed this move saying that because  the Resolutions stand on their own there was no need to refer to them.  Australia and Botswana suggested that paragraphs from the relevant WHA texts could be referenced and, after the World Health Organisation (WHO) explained the importance of the Resolutions,  the EU and US agreed to a compromise. (5) 

Experts from the International Baby Food Action Network (IBFAN) suggest that as the EU and US economic crisis continues, the  new ‘business of malnutrition’  - which has the potential for multi-billion dollar profits from exports to the developing world and is portrayed as a win-win solution for the economy and development – could lead to a marketing bonanza that,  instead of improving infant and young child health, could lead to double burden of malnutrition, both under and over nutrition, while draining family budgets.(6)

The debate centred on a proposal by Ghana to update existing Codex Guidelines for a range of complementary fortified foods. Ghana, the majority of African and Latin American countries, IBFAN, the Internatonal Association of Consumer Food Organisations (IACFO) and the International Lactation Consultant Association (ILCA) were anxious to protect breastfeeding, local family foods and skills and to improve the safety and quality of these foods.(7)  However, their task was made especially tricky because of the extensive food industry presence – the norm for Codex meetings. 40% of the 268 delegates were food industry, with 59 attending as members of Business Interest NGOs (BINGOS) and 49 included on government delegations – some even heading these delegations. For example, the Mexican delegation, which made many industry-friendly interventions, was 100% industry, with US baby food companies Mead Johnson and Abbott alongside Kelloggs and Coca Cola. Germany hosted the meeting and 12 of its 15 delegates were industry, including baby food giants, Milupa (Danone) and Nestlé, alongside Coca Cola, Kraft, Merk, and others.   This brings into context the calls by the Conflict of Interest Coalition which is urging the United Nations to develop a Code of Conduct and Ethical Framework for interacting with the private sector and managing conflicts of interest. (5)

The health advocates acknowledged that the fortification of basic foods can be an important health intervention if properly managed, but had serious concerns about this untested market-led approach to malnutrition  in relation to infant and young child feeding

Malang Fofana, the head of the Gambia delegation, said: “The resistance from the exporting countries to sensible controls on the marketing of these products has left me very worried. Because of the move to ‘product-based’ solutions, funding is already drying up for most infant and young child feeding support programs and for community-based approaches that teach and promote skills to make nutritious family foods from local indigenous ingredients. I fear that once this runaway train leaves the station there will be no stopping it.” 

Joyce Chanetsa, IBFAN’s Regional Coordinator for Africa and Chair of the African Codex Experts Group:“We accept that these products may provide important nutrients when used in certain situations, but if they are promoted as quick fix magic bullets on the market that will end malnutrition, parents will do anything to buy them, however unaffordable and unnecessary they may be.  Once market-led programs overtake other humanitarian and development interventions, the underlying and root causes of poverty and malnutrition are forgotten.  If malnutrition in all its forms is to be a sustainable business, demand needs to be maintained. Is this the vision for Africa that the poor remain impoverished and needy?” 

In response the  US and the EU opposition to references to the WHA Resolutions,  WHO clarified that it was indeed appropriate to cite them: “While the WHA Resolutions are not legally binding under the constitution – it doesn’t mean that the Resolutions are just paper and devoid of effect. [They] constitute the international practice and a consensus language that is also used in other international fora, for instance they are used customarily in WTO litigations.”

The EU and US eventually gave way, taking up Brazil's suggestion to allow a reference to the 2001 WHO Global Strategy for Infant and Young Child Feeding  and WHA Resolution  54.2 2001 (5) but refusing the newer Resolutions.  (4)  Several other sections of the guidelines relating to food safety and quality were improved, but invariably, as is usual in Codex, exporting country views carried more weight than those on the receiving end.  With meeting time fast running out the Codex requirement to reach consensus was not followed on important questions of marketing, such as whether the products could share the same brand name as formulas, whether they should carry a statement recommending continued breastfeeding and whether they could be advertised.

However on the key issue of claims, a proposal by the Global Alliance for Improved Nutrition (GAIN), (9) to allow promotional claims was not taken up. GAIN is a public private partnership, that works with over 600 companies, including Danone (the second largest baby food company), PepsiCo, Mars and Kraft, and which promotes market-led approaches to ‘prevent malnutrition.’ The US initially supported the GAIN proposal, but softened its approach and suggested that Codex needed to explore how products could make a statement about their intended purpose without ‘simply being viewed as a claim.’  IBFAN and IACFO picked up on this point, highlighting the risks of promotional claims, especially when products share brand names with breastmilk substitutes and stating that here are other ways to present nutrition information and make the intended purpose and appropriate use clear.  GAIN argued that because all sorts of inappropriate claims are made on other foods (many in contravention of Codex guidelines and WHA Resolutions)(8)  these new foods need claims to be commercially competitive. Overlooked is the fact that GAIN’s approach would, undermine the efforts of those governments trying to protect child health by banning promotional claims on all foods for infants and young children.

Hussein Tarimo, speaking for Botswana, called for many safeguards, including on the safety of ingredients and manufacturing processes, some of which were taken up.  However others were not, for example that labels should stress the importance of sustained breastfeeding after 6 months, that industrial by-products such as de-fatted cotton-seed flour (used as animal feeds or fertilizer) should not be used in baby foods. He also said that products for making baby foods should not be irradiated.

Speaking after the meeting, Abdulsalam Ozigis, of the Nigeria Food and Drug Administration,  expressed concern about the report of the meeting which referred to the use of family foods after 12 months while the guidelines recommend products for use from 6 months. He feared that this message would undermine the Government’s message that the processed foods should be used only to supplement family foods not replace them. Kenya also called for the products to be used in consultation with health workers in line with government health programs – a point that was partially addressed in a surprise move by the EU, but one which also introduced the possibility of a weakening of the recommended age for these products. 

Because so much agenda time was spent on discussion about other nutrition issues, such as the necessary level of scientific evidence needed for setting nutrient reference values and labelling, there was no time to address the New Zealand proposal  for a review of the Follow-on Milk standard and the Indian Proposal for cereal-based foods for underweight children. In their comments, IBFAN and IACFO highlighted the harm caused by the marketing of milks for older babies, which are not necessary and should be the same composition as infant formula. (11)

For more information contact: Patti Rundall, Baby Milk Action/IBFAN/IACFO +44 7786 523493 prundall@ babymilkaction.org, Elisabeth Sterken: National Director, INFACT Canada esterken@infactcanada.ca