8A.5 Example of UK multiple traffic light front-of-package labeling

This finding, in contrast to Mexico’s experience, highlights the need for sufficiently large price changes to result in measurable responses.

There is ongoing discussion around furthering policy integration efforts by linking the tax designs in Chile with its Food Labeling and Marketing Law. Simulations of expanding the tax to include unhealthy processed foods in Chile show that with such a tax, in line with food labeling and marketing regulations, household purchases of these items would fall dramatically (Caro et al. 2017; Colchero, Paraje, and Popkin 2020). In addition, there would be reductions in nutrients of concern in Chile (sugar, sodium, saturated fats, and calories) linked with the most common NCDs (Caro et al. 2017).

The United Kingdom

The United Kingdom began with a more voluntary approach involving public-private partnerships. In more recent years, however, it has shifted toward more regulatory approaches because of a lack of progress or improvement from approaches that are based on such partnerships, combined with greater urgency regarding the dangers of obesity and NCDs in its population, particularly in the context of the COvID-19 pandemic.

In 2011 the UK Department of Health launched the Public Health Responsibility Deal, which sought to use a systems approach to work collectively with businesses and the voluntary sector to deliver public health improvements through their influence on food, alcohol, physical activity, behaviors, and health in the workplace (Knai et al. 2018). Each of the five network participants (food, alcohol, physical activity, health at work, and behavior change) agreed to an initial set of collective pledges (DOH n.d.). Alcohol and food pledges have a strong focus on actions that manufacturers, retailers, and the out-of-home dining and catering sector as well as bars and pubs can deliver (DOH n.d.). Part of this pledge also included manufacturers voluntarily applying a multiple traffic light (MTL) logo, to show whether a product is high (red), medium (amber), or low (green) in fat, saturated fat, salt, and sugars, including the total calories (kilocalories and kilojoules) it provides (figure 8A.5).

Independent evaluations of the Responsibility Deal suggest that companies’ progress reports were of poor quality and difficult to harmonize across companies

FIGURE 8A.5

Example of UK multiple traffic light front-of-package labeling

Each serving (150g) contains

Of an adult’s reference intake Typical values (as sold) per 100 g: 697kJ/167 kcal

Energy 1046KJ 250 kcal

Fat 3.0g

Saturates 1.3g

Sugars 34g

Salt 0.9g

Low Low High Med

13% 4% 7% 38% 15%

Source: Food Standards Agency 2020. Note: g = grams; kcal = kilocalories; kJ = kilojoules.

(there was a lack of common metrics), and the food pledges did not reflect the most effective strategies to improve diet (Knai et al. 2015). Additionally, companies appeared to have committed to interventions that probably were already under way (the added value of pledges was minimal), allowing companies the opportunity to present themselves favorably while legitimizing industry’s involvement in public health policies (Douglas et al. 2018). Moreover, the lack of enforcement or penalty limited the ability of the Responsibility Deal to encourage companies to go beyond business as usual (Knai et al. 2015), and therefore will not produce meaningful health improvements (Laverty et al. 2019).

In 2018, the UK government implemented the Soft Drink Industry Levy (SDIL), which was explicitly designed to encourage producers of added-sugar soft drinks to reformulate their products (GOv.UK 2016b). The SDIL applies to the production and importation of soft drinks (and alcoholic drinks with up to 1.2 percent alcohol by volume) containing added sugar. It has a lower rate for added-sugar drinks with a total sugar content of 5 g or more per 100 milliliters (ml) and a higher rate for drinks with 8 g or more per 100 ml. The objectives of the SDIL were to reduce the sugar content in products, reduce portion sizes for added-sugar drinks, and induce importers to import reformulated drinks with low added sugar to encourage consumers of soft drinks to move to healthier choices.

Evaluations of whether and to what extent the reformulation and reduction pledges and the SDIL have contributed to reformulations have occurred and are continuing. To date, findings from the voluntary targets have been mixed across various outcomes on salt (Public Health England 2020a), sugar (GOv.UK 2018, 2019; Public Health England 2020b), and calorie reduction. Meanwhile, sugar reduction from the UK SDIL (SSB tax) is much greater than that seen for the food categories included in the voluntary sugar reduction program. Additionally, independent evaluations of the SDIL (White et al. n.d.) suggest that reformulations, changes in product offerings, and overall reductions in purchases of high-sugar beverages have occurred (Bandy et al. 2020; Scarborough et al. 2020).

Since 2019, the UK government has been taking a cross-department regulatory approach in tackling other action items from its Childhood Obesity: A Plan for Action report (GOv.UK 2016a). This approach was further bolstered by the Tackling Obesity Government Strategy, introduced in July 2020 in recognition that people living with overweight or obesity are at greater risk of being seriously ill and dying from COvID-19. As part of all these efforts, the UK government has been seeking public comments on several regulatory actions:

• January 2019: Restricting promotions of food and drink high in fat, sugar, and salt (HFSS) by location (restricting the placement of HFSS food and drink at main selling locations in stores, such as checkouts, aisle ends, and store entrances) and by price (restricting volume-based price promotions of HFSS food and drink that encourage people to buy more than they need—for example, “buy one, get one free” and free refills of sugary soft drinks). • February 2019: Banning direct advertising of HFSS foods and beverages on the entire Transport for London network as part of the larger London Food Strategy. • March 2019: Further advertising restrictions in place until after 9 pm for

HFSS products to reduce children’s exposure to HFSS product advertising on

Tv and online. • July 2020: Revisiting the existing voluntary FOPL MTL system in the United

Kingdom, in terms of what nutrients to include and whether there should be changes to the existing FOPL.