WHO events addressing public health priorities

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A regional roadmap to address unopposed marketing of unhealthy foods/beverages to children in the Eastern Mediterranean Region¹

¹ This report is extracted from the Summary report on the Expert meeting to finalize a regional roadmap to address unopposed marketing of unhealthy foods/beverages to children in the Eastern Mediterranean Region, Cairo, Egypt 21–22 June 2016 (http://applications.emro.who.int/docs/IC_Meet_Rep_2016_EN_19189.pdf?ua=1, accessed 8 March 2017).

Childhood overweight and obesity have reached alarming levels, both globally and in the WHO Eastern Mediterranean Region (EMR). In 2014, an estimated 41 million children under five years of age were overweight or obese, with the Region ranked third in prevalence, closely behind the Region of the Americas (1). Global data shows that in absolute numbers there are more overweight or obese children living in low- and middle-income than high-income countries (1). However, in the EMR, child overweight or obesity has become a notable public health challenge in high-income countries, affecting more than 50% of children in certain age groups (2).

Obesity is a key concern because it may cause chronic noncommunicable diseases, has the potential to negate health gains and may affect quality of life and life expectancy. In the Region, noncommunicable diseases are already responsible for over 50% of mortality and more than 60% of the morbidity burden, with countries facing challenges in responding to current health needs (2). Policy measures that address the prevention of childhood overweight and obesity are of critical importance in preventing and mitigating noncommunicable diseases. A key factor in the rise in childhood overweight and obesity is the widespread growth of an obesogenic environment with increased marketing of foods high in saturated fats, trans-fatty acids, free sugars or salt, specifically targeting children. Studies have shown that the marketing of these types of foods influences children’s food preferences, requests and consumption (3).

In 2010, the Sixty-third World Health Assembly in resolution 63.14 endorsed a set of recommendations on marketing of foods and non-alcoholic beverages to children and called on Member States to restrict marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free-sugars or salt (4).

In 2011, the United Nations (UN) Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases urged Member States to promote the implementation of these recommendations (5). In 2012, the WHO Regional Committee for the Eastern Mediterranean (RC-EMR) endorsed a regional framework for action, with strategic interventions and indicators to assess country progress, as a road map for countries to implement the UN Political Declaration (6). Subsequently, in 2014, a ministerial panel discussion on the prevention of noncommunicable diseases held during the Sixty-first session of the WHO RC-EMR raised concern over the largely unopposed commercial practices that promote unhealthy products, particularly those targeting children (7), and in 2015, WHO held an open forum on addressing unopposed marketing of unhealthy foods and beverages to children in Amman, Jordan (8).

Recently, WHO organized an expert meeting to finalize a regional roadmap to address unopposed marketing of unhealthy foods/beverages to children in the Eastern Mediterranean Region held in Cairo, Egypt on 21–22 June 2016 (9). The expert meeting was attended by global and regional experts in the areas of childhood overweight and obesity, marketing, the media and public health, and WHO staff from headquarters and regional levels.

The objectives of the meeting were to:

review the open forum recommendations;

review the current evidence; and

agree on a roadmap to address unopposed marketing of unhealthy foods / beverages to children in the Region.

Key challenges in the Region

The Region has a particular problem with childhood overweight and obesity, with rates reaching as high as 14% and 22% amongst adolescent’s aged 13–15 in some countries (2). There is a well-established evidence base showing that the marketing of unhealthy food and beverages is driving this epidemic (3).

The Region represents a major and rapidly growing market for the unhealthy food and beverage industries and these industries are among the top spenders on marketing. While marketing of unhealthy food and beverages is already extensive, increases in expenditure and the number of communication channels mean that it will continue to grow.

Television remains the most important medium for advertising unhealthy food and beverages, but advertising through digital media is also growing rapidly. Extensive use is also made of celebrities and sponsorship of youth-oriented programmes and events. An increasingly common language and culture among young people is extending the reach of marketing beyond national borders, especially via private satellite television broadcasting outlets. This cross-border marketing requires regulation in both source and recipient countries (9).

As a response to the above challenges, WHO launched a regional initiative to address the issue with the support of global experts and through various forms of consultation, to explore strategic ways to address unopposed marketing of food and non-alcoholic beverages specifically targeting children.

Recommendations

The following strategies and interventions for Member States were identified by the experts to address the unopposed marketing of unhealthy foods and beverages.

1. Banning advertising of food high in saturated fats, trans-fatty acids, free sugars or salt to children in all media.
2. Specifying children’s television watching hours for non-advertising of food high in saturated fats, trans-fatty acids, free sugars or salt; for example, non-advertising if 10% of the audience is under 16 years or non-advertising before 22.00 hours.
3. Banning marketing of unhealthy foods and beverages high in saturated fats, trans-fatty acids, free sugars or salt in school premises and surroundings, as well as other places frequented by children (such as hospitals).
4. Introducing effective taxes (above 20%) on sugar-sweetened drinks.
5. Mandating interpretive front of pack labelling supported by the public education of both adults and children for nutrition literacy.
6. Banning the use of branded and licensed cartoons, toys, gifts and other inducements.
7. Imposing a levy on remaining marketing of unhealthy food and beverages to fund public authorities to monitor impact of policies.
8. Undertaking consistent social marketing and school-based education to increase awareness and understanding of potential harms and manipulation caused by unhealthy food and beverage marketing.
9. Adapting school curricula to educate children (and parents) about the manipulative and harmful nature of unhealthy food and beverage marketing.
10. Working with audiovisual and broadcasting authorities (satellite television and other channels) to control cross-border advertising.
11. Setting up a communication mechanism for people to express their concerns.

References

1. World Health Organization. Overweight and obesity: factsheet. Geneva: World Health Organization; 2016 (http://www.who.int/mediacentre/factsheets/fs311/en/, accessed 8 March 2017).
2. World Health Organization. Regional strategy on nutrition 2010–2019. Cairo: Regional Office for the Eastern Mediterranean; 2010 (http://applications.emro.who.int/docs/EM_RC57_4_en.pdf?ua=1, accessed 8 March 2017).
3. Jolly R. Marketing obesity? Junk food, advertising and kids. Canberra: Parliament of Australia; 2011 (http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1011/11rp09, accessed 8 March 2017).
4. World Health Organization 63rd World Health Assembly. Marketing of food and non-alcoholic beverages to children, agenda item 11.9. Geneva: World Health Organization; 2010 (http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R14-en.pdf, accessed 8 March 2017).
5. United Nations General Assembly. High level meeting on prevention and control of non-communicable diseases. New York: United Nations; 19–20 September 2011 (http://www.un.org/en/ga/ncdmeeting2011/, accessed 8 March 2017).
6. World Health Organization. Noncommunicable diseases: regional framework for action. Cairo: Regional Office for the Eastern Mediterranean; 2012 (http://www.emro.who.int/noncommunicable-diseases/framework-for-action/index.html, accessed 8 March 2017).
7. Sixty-first session of the WHO regional committee for the Eastern Mediterranean. Cairo: Regional Office for the Eastern Mediterranean; 2014 (http://www.emro.who.int/about-who/rc61/sixty-first-session-of-the-regional-committee-for-the-eastern-mediterranean.html, accessed 8 March 2017).
8. WHO Regional Office for the Eastern Mediterranean. Open forum on addressing unopposed marketing of unhealthy foods and beverages to children. Amman, Jordan, 13–14 September 2015 (http://apps.who.int/iris/handle/10665/204297, accessed 8 March 2017).
9. WHO Regional Office for the Eastern Mediterranean. Expert meeting to finalize a regional roadmap to address unopposed marketing of unhealthy foods/beverages to children in the Eastern Mediterranean Region, Cairo, Egypt 21–22 June 2016 (http://applications.emro.who.int/docs/IC_Meet_Rep_2016_EN_19189.pdf?ua=1, accessed 8 March 2017).