Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children

Bull World Health Organ 2016;94:540–548 | doi: http://dx.doi.org/10.2471/BLT.15.158667 Policy & practice 540 Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children Vivica I Kraak,a Stefanie Vandevijvere,b Gary Sacks,c Hannah Brinsden,d Corinna Hawkes,e Simón Barquera,f Tim Lobsteind & Boyd A Swinburnb Introduction In May 2010, the 192 Member States of the World Health Organization endorsed Resolution WHA63.14. The aim of this resolution is to restrict the marketing of unhealthy food and non-alcoholic beverage products to children and adoles- cents to reduce the prevalences of overweight, obesity and diet-related noncommunicable diseases.1 Globally, about 42 million children younger than 5 years and 155–200 million school-aged children are overweight or obese.2,3 Nearly 2.7 billion adults will be overweight or obese by 2025.4 The rapid increase in the prevalence of overweight and obesity among children in low- and middle-income countries has been de- scribed as a time bomb that could cause immense damage to health-care systems worldwide.5 We examined the actions taken, between 2010 and early 2016, by the World Health Organization (WHO) – via its headquarters and six regional offices – and other United Na- tions (UN) organizations to offer technical and policy guid- ance to Member States to implement Resolution WHA63.14. We subsequently assessed the extent of the same resolution’s implementation by the national governments of Member States and investigated the supportive actions of relevant civil society organizations, philanthropic institutions and transnational industrial actors – e.g. food and beverage manufacturers, re- tailers, restaurant companies and industrial trade groups. We focused on actions designed to restrict young people’s exposure to the powerful and pervasive marketing of branded unhealthy food and non-alcoholic beverage products – i.e. products that are high in saturated fats, trans fatty acids, free sugars and/or salt. Below, we present the results of these investigations and suggest strategies and actions to accelerate the implementation of Resolution WHA63.14. Marketing, diet and health risks A robust evidence base accumulated between 2003 and 2013 demonstrated how the extensive and persistent exposure to the powerful marketing of unhealthy food and beverage products could affect the food and drink preferences and purchase requests of children and adolescents.6–10 Rigorous reviews have documented how the often sophisticated and integrated marketing communications of transnational food and drink industries continue to influence the dietary behav- iours of young people and contribute to energy-dense and nutrient-poor diets, increased risks of unhealthy weight gain and negative health outcomes.7–10 As they have a biological preference for sweet and salty tastes, infants and young children younger than 5 years are considered especially vulnerable to marketing practices that promote sugary and salty food and beverage products.11 Children’s recognition of branded food logos increases with age12 and overweight children are more likely to recognize the brands of fast food restaurants than those of other food and beverage products.13 Compared with other children, those who recall branded unhealthy food and beverage products have stronger preferences for such products.14 Children’s knowledge of unhealthy food and beverage products increases their obesity risk.15 Adolescents aged 12–18 years have more discretionary income than children and are uniquely suscep- tible to an immersive and evolving digital marketing landscape that normalizes unhealthy food and beverage products.16 Such Abstract In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 – by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries – to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030. a Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 223 Wallace Hall, 295 West Campus Drive, Blacksburg, Virginia 24061, United States of America. b School of Population Health, University of Auckland, Auckland, New Zealand. c WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Australia. d World Obesity Federation, London, England. e Centre for Food Policy, City University London, London, England. f National Institute of Public Health of México, Cuernavaca, Mexico. Correspondence to Vivica I Kraak (email: vivica51@vt.edu). (Submitted: 22 May 2015 – Revised version received: 10 February 2016 – Accepted: 12 February 2016 – Published online: 27 April 2016 ) Bull World Health Organ 2016;94:540–548| doi: http://dx.doi.org/10.2471/BLT.15.158667 541 Policy & practice Restricting the marketing of unhealthy foods and beveragesVivica I Kraak et al. marketing is also associated with mate- rialistic values and aspirational lifestyles that often have harmful impacts among young people.17 Technical and policy guidance Following the adoption of Resolution WHA63.14,1 WHO released 12 recom- mendations18 that encouraged national governments to: (i) implement policies to restrict the marketing of unhealthy food and beverage products in settings where children spend time; (ii) reduce the impact of the cross-border market- ing of such products; and (iii) monitor the nature and extent of the marketing of such products and the effectiveness of government regulations to restrict young peoples’ exposure to – and the harmful impacts of – such marketing. We summarize below the evidence of the leadership provided, between 2010 and early 2016, by WHO’s headquarters and regional offices and other UN agencies – via the provision of technical and policy guidance and tools to assist Member States in the protection of young people from the marketing of unhealthy food and beverage products (Fig. 1). In 2011, the Pan American Health Organization (PAHO) adapted WHO’s 12 recommendations for use in 47 countries.19 In 2012, WHO developed a comprehensive framework that offered Member States the technical support they might need to restrict and moni- tor marketing practices that promoted unhealthy branded food and beverage products across media platforms, vari- ous settings and country borders.20 In 2013, however, WHO’s Regional Office for Europe released data, from moni- toring activities in 53 countries, that demonstrated many weaknesses in the framework – e.g. an overreliance on vol- untary pledges, the exploitation of loop- holes by food, beverage and restaurant industries and insufficient government regulation and enforcement.21 In 2012, inspired by the protect, respect and remedy accountability framework previously developed by the UN, the United Nations Children’s Fund (UNICEF), the UN Global Compact and Save the Children jointly released model business practices to protect children’s rights.22 These practices were reinforced Fig. 1. Support to restrict the marketing of branded high-fat, salty and/or sugary food and beverage products to children and adolescents, 2010–2016 UNGC released the Business for the rule of law framework (2015) WHO Global action plan for the prevention and control of noncommunicable diseases to reduce NCDs by 25% by 2025 Member States endorsed Resolution WHA63.14 in Geneva, Switzerland (May 2010) WHO Regional Office for Europe released a monitoring report of HFSSFBP marketing across 53 countries (2013) UNGC, UNICEF and Save the Children released the Children’s rights and business principles report (2013) WHO released 12 recommendations for national governments to restrict HFSSFBP marketing to children and adolescents (Dec 2010) WHO released a monitoring and evaluation framework to help national governments implement the 12 recommendations and WHA63.14 Resolution (2012) FAO and WHO jointly released the ICN2 Rome Declaration on Nutrition and Framework for action that urged Member States to implement a legislative framework to regulate HFSSFBP marketing to children and adolescents (2014) WHO Regional Office for the Western Pacific released a report with strategies and recommendations to restrict HFSSFBP marketing to children and adolescents for 27 countries (2014) PAHO/WHO Regional Office for the Americas released a report with recommendations to restrict HFSSFBP marketing to children and adolescents for 47 countries (2011) WHO released the Global action plan for the prevention and control of noncommunicable diseases, with indicator 23 to restrict HFSSFBP marketing to children and adolescents (2013) WHO Regional Office for Europe adopted a uniform nutrient-profiling system to guide government legislation and regulation to restrict HFSSFBP marketing to children and adolescents for 53 countries (2015) WHO Commission on Ending Childhood Obesity (ECHO) report highlights need to reduce HFSSFBP marketing to prevent obesity and diet-related NCDs (Jan 2016) UN sustainable development goal 3: ensure healthy lives and well-being for all by 2030 2010 2013 2015 2011 2012 2014 2016 2017 203020252020 FAO: Food and Agriculture Organization of the United Nations; HFSSFBP: high-fat, salty and/or sugary food and beverage products; ICN2: Second International Conference on Nutrition; INFORMAS: International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support; NCDs: noncommunicable diseases; PAHO; Pan American Health Organization; UN: United Nations; UNGC: United Nations Global Compact; UNICEF: United Nations Children’s Fund; WHA: World Health Assembly; WHO: World Health Organization. Note: The support shown was provided by the World Health Organization and other United Nations agencies to Member States. The figure also shows some goals to be achieved by 2030. Bull World Health Organ 2016;94:540–548| doi: http://dx.doi.org/10.2471/BLT.15.158667542 Policy & practice Restricting the marketing of unhealthy foods and beverages Vivica I Kraak et al. in 2015 by the UN Global Compact’s release of the Business for the rule of law framework.23 In 2013, WHO released the Global action plan for the prevention and control of noncommunicable diseases, 2013–2020. This plan included an in- dicator to monitor the restriction of the marketing of unhealthy food and beverage products to individuals aged 0–18 years, to help reduce premature mortality from noncommunicable diseases by 25% by 2025.24 WHO asked policy-makers and decision-makers within national governments to mobilize the political will, allocate the financial resources and create the transparent accountability mechanisms needed to ensure national legislation to monitor this marketing indicator.24,25 In 2014, WHO’s Regional Office for the Western Pacific outlined strategies that national governments could use to regulate prac- tices that encouraged the marketing of unhealthy food and beverage products and counteract the attempts of some food industries to undermine the devel- opment of supportive policies.26 Over 2200 people, including repre- sentatives of 170 Member States, attend- ed the Second International Conference on Nutrition in November 2014. The at- tendees endorsed the Rome Declaration on Nutrition that called for “improve- ments in diet and nutrition and requir- ing a relevant legislative framework … while avoiding inappropriate marketing and publicity of foods and non-alcoholic beverages to children, as recommended by Resolution WHA63.14”.27 The con- ference’s Framework for action urged national governments to implement co- herent policies and coordinated actions across sectors to “regulate the marketing of food and non-alcoholic beverages to children according to the WHO’s 2010 recommendations.”28 In 2015, WHO’s Regional Office for Europe released a food- and nutrient- based profiling model to help govern- ments reduce the marketing of un- healthy food and beverage products to young people.29 This model is currently being adapted for use by the Regional Offices for the Eastern Mediterranean and Western Pacific (Chizuru Nishida, WHO, personal communication, 2015). In 2016, PAHO released a nutrient- profile model developed for several purposes, including the reduction of the marketing of unhealthy food and beverage products to young people.30 In 2016, WHO’s Report of the com- mission on ending childhood obesity31 recognized that the “settings where children and adolescents gather and the screen-based offerings they watch, should be free of marketing of unhealthy foods and sugar-sweetened beverages”. The report also noted, with concern, that Member States had failed to give signifi- cant attention to Resolution WHA63.14 and requested that they address this issue. The Commission urged Member States to: (i) implement the recom- mendations to restrict young people’s exposure to – and the power of – the marketing of unhealthy food and bev- erage products; (ii) cooperate to reduce the impact of the cross-border market- ing of such products; and (iii) develop nutrient-profiling systems to identify and regulate such products.31 Progress National governments Since 2010, many national govern- ments have favoured self-regulation by industry to restrict the marketing of un- healthy food and beverage products.32–34 A survey of 59 countries in 2011 showed that, although national governments had developed or implemented some relevant statutory measures, the nature and extent of the marketing restrictions differed across countries and regions.35 No Member State has implemented comprehensive legislation or enforced mandatory regulations to prohibit the marketing of fatty, salty and/or sugary branded food and non-alcoholic bever- age products to young people. Transnational industrial actors In 2012, the International Chamber of Commerce released a Framework for responsible food and beverage marketing communications that reflected principles of a broader International Code on Advertising. These principles, which are supported by the World Federation of Advertising and other International Chamber of Commerce members, were designed to promote ethical and legal standards for voluntary self-reg- ulation of business marketing practices (Fig. 2).36 Many of the largest food and beverage manufacturers worldwide have pledged to restrict the advertising – but not all forms of the marketing – of branded food and beverage products with high levels of fat, sugar and/or salt to children younger than 12 years. In 2014, 11 companies within the Interna- tional Food and Beverage Alliance re- ported that they had stronger voluntary pledges than in 2011,37 continued to sup- port third-party compliance monitoring – by Accenture (Dublin, Ireland) – and promised that, by 2016, they would only advertise products to children younger than 12 years that met common nutri- tion criteria based on scientific dietary guidelines.37 In 2014, the members of the Consumer Goods Forum – a consortium of over 400 food manufacturers and retailers across 70 countries – pledged that, by 2018, they would stop advertis- ing, to children younger than 12 years, food and beverage products that do not meet science-based nutrition criteria (Fig. 2).38 The Access to Nutrition Foundation – a private health-related philanthropic institution –released its first Access to nutrition index, a global monitoring report, in 2013.39 This report rated 22 transnational food and beverage manufacturers across nine indicators, one of which was responsible food and beverage marketing practices. A score of 10 represented the highest level of coordinated actions to support responsible marketing to children and adults. Among the companies within the International Food and Beverage Alliance, the scores for responsible marketing fell from 5.2 for Danone, to 4.8 for Unilever, 4.6 for PepsiCo, 4.4 for Kraft Foods, 4.1 for The Coca-Cola Co., 4.0 for Nestlé and 2.7 for Kellogg. In the corresponding report for 2016, many companies’ marketing scores were higher than their 2013 values, with Danone (8.5), Unilever (7.7) and Nestlé (7.4) leading the marketing index.40 Compared with the 2013 report, the 2016 report indicated no measurable improvement in the prioritization and implementation of a global policy for the responsible marketing of healthy food and beverage products. Both the 2013 and 2016 reports of the Access to Nutrition Foundation recommended that transnational food and beverage firms increase their transparency and accountability to enable independent monitoring bodies to assess their prog- ress and develop corrective actions. No company has yet restricted the marketing of unhealthy food and bever- age products comprehensively – i.e. in all settings, for all practices and across all media platforms – either to children Bull World Health Organ 2016;94:540–548| doi: http://dx.doi.org/10.2471/BLT.15.158667 543 Policy & practice Restricting the marketing of unhealthy foods and beveragesVivica I Kraak et al. younger than 12 years or to adolescents aged 12–18 years. Moreover, food retail- ers, entertainment companies and many firms that operate fast food restaurants in chain franchises have failed to adopt any global commitments similar to the pledges made by the Consumer Goods Forum, the International Food and Beverage Alliance or the International Chamber of Commerce. Some transnational companies use private-sector alliances to persuade leg- islators and the public to oppose health- related restrictions on food and drink marketing. These attempts have fuelled government inaction and weakened civil society’s response to the implementation of Resolution WHA63.14.41 However, industry actors are partnering with some UN agencies, including UNICEF and the World Food Programme, to address the problems of hunger and undernutrition in countries with rising prevalences of obesity and diet-related noncommunicable diseases.41 These partnerships must be carefully vetted to prevent, manage and mitigate any potential conflicts of interest and avoid the risks and consequences associated with the promotion of unhealthy food and beverage products while addressing undernutrition. Civil society and philanthropic organizations The focus of civil society efforts has been to monitor the policies and ac- tions of transnational industrial actors and national governments (Fig. 2). In 2011, Consumers International released a guide to encourage civil society orga- nizations to monitor the marketing of unhealthy food and beverage products that targeted children and adolescents.42 Between 2010 and 2015, comprehensive monitoring and evaluation reports published by academics and civil soci- ety organizations32,43–46 showed several inconsistencies among the voluntary pledges used by various transnational industrial actors across geographical areas. These reports emphasized the inherent weaknesses of industry-funded self-regulatory programmes, and deci- sion-makers who lack the authority and resources to hold underperforming or non-compliant businesses accountable for marketing practices that contribute to obesity and diet-related noncom- municable diseases. The Rudd Center’s Fig. 2. Progress achieved in restricting the marketing of branded high-fat, salty and/or sugary food and beverage products to children and adolescents, 2010–2016 WHO Global action plan for the prevention and control of noncommunicable diseases to reduce NCDS by 25% by 2025 ATNF released the first ATNI monitoring report for 22 companies with scores for responsible food marketing to children (2013) INFORMAS was established to monitor government and industrial progress to improve food environments, including restricting HFSSFBP marketing to children and adolescents (2013) ICC released Framework for responsible food and beverage marketing communications for children (2012) Consumers International released a guide for civil society organizations to monitor HFSSFBP marketing targeted to children and adolescents (2011) Member States and most national governments support industrial self-regulation. Some governments have passed partial HFSSFBP restrictions but policies differ across countries and broader geographical areas (2010) WCRF International established the NOURISHING framework to monitor progress of national governments to implement HFSSFBP marketing restrictions (2013) Rudd Center’s monitoring of 24 transnational industrial actors’ pledged across 17 countries revealed industrial pledges do not cover all HFSSFBP marketing practices to children and adolescents (2014) CGF companies pledged to meet commitments for responsible advertising to children aged under 12 years by 2018 (2014) IFBA companies pledged to meet responsible advertising to children aged under 12 years by 2016 (2014) Consumers International and WOF released a model Framework Convention to Protect and Promote Healthy Diets (2014) Consumers International released a survey of about 3000 adults across 6 countries that showed the public is largely unaware of the economic costs of an unhealthy diet on population health (2015) Member States have not implemented comprehensive legislation or enforced mandatory regulations for full restriction of HFSSFBP marketing to children and adolescents (2015) ATNF released the second ATNI monitoring report for 22 companies with scores for responsible food marketing to children (2016) UN sustainable development goal 3: ensure healthy lives and well-being for all by 2030 2013 2015 2014 2016 2010 2017 20122011 203020252020 ATNF: Access to Nutrition Foundation; ATNI: Access to Nutrition Index; CGF: Consumer Goods Forum; HFSSFBP: high-fat, salty and/or sugary food and beverage products; ICC: International Chamber of Commerce; IFBA: International Food and Beverage Alliance; INFORMAS: International Network for Food and Obesity/Non- communicable Diseases Research, Monitoring and Action Support; NCDs: noncommunicable diseases; UN: United Nations; WCRF: World Cancer Research Fund; WHO: World Health Organization; WOF: World Obesity Federation. Note: The progress shown was achieved by civil society organizations, national governments in Member States and transnational industrial actors. The figure also shows some goals to be achieved by 2030. Bull World Health Organ 2016;94:540–548| doi: http://dx.doi.org/10.2471/BLT.15.158667544 Policy & practice Restricting the marketing of unhealthy foods and beverages Vivica I Kraak et al. monitoring of the voluntary pledges of transnational industrial actors across 17 countries and four global areas46 revealed that none of the 24 companies investigated had extended pledges to cover all food and/or beverage market- ing practices that targeted adolescents aged 14–18 years. In 2013, the World Cancer Research Fund International established the NOURISHING framework to monitor the progress of national governments to implement restrictions on the marketing of unhealthy food and beverage prod- ucts.34 The International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Ac- tion Support (INFORMAS) was estab- lished to monitor the progress of nation- al governments and diverse industrial sectors in improving the healthiness of food – including the restriction of mar- keting of unhealthy food and beverage products to children and adolescents.45,47 In 2014, Consumers International and the World Obesity Federation outlined guiding principles, general obligations and 14 specific articles for a model Framework Convention to Protect and Promote Healthy Diets48 and advocated for WHO to work with Member States to enact mandatory actions and strong accountability structures to address unhealthy diets. Priority strategies and actions Table 1 summarizes our recommenda- tions for policy development, imple- mentation, monitoring and evaluation by diverse stakeholders. If followed, these recommendations should help in the full implementation of Resolution WHA63.14, the reduction of the prema- ture mortality from noncommunicable diseases by 25% by 202525 and the sus- tainable development goal to achieve healthy lives for all by 2030.49 Civil society and philanthropic organizations Health-related civil society and phil- anthropic organizations can support national governments in establishing and strengthening regulatory bodies that are empowered to define and re- strict the marketing of unhealthy foods and beverages targeted at children and adolescents – and to hold private-sector businesses to account for such market- ing. Smaller civil society organizations will need support to develop the effec- tive advocacy and social momentum they will need to build an enabling environment – i.e. one in which national governments and UN agencies may fulfil their commitment to enact and Table 1. Priority strategies and actions for accelerating progress towards full implementation of Resolution WHA63.14 by 2025 Actors Policy development Policy implementation Policy monitoring and evaluation Health-related civil society and philanthropic organizations Provide advocacy and social- movement building skills to create an enabling environment for national governments and UN agencies to uphold strong legislation to support this issue. Offer clear guidelines for voluntary engagement and disengagement with transnational industrial actors through alliances and partnerships. Use media advocacy to raise public awareness about the global costs of an unhealthy diet, to strengthen public support for restrictions on HFSSFBP and establish strong accountability systems that include financial penalties for non-compliant companies and industry sectors that do not protect young people from the marketing of HFSSFBP. Conduct and publish independent monitoring and evaluations of progress achieved by Member States and transnational industrial actors to restrict the marketing of HFSSFBP. National governments of Member States Set clear goals and targets to restrict young people’s exposure to branded HFSSFBP. Enact legislation and regulation in accordance with Resolution WHA63.14 and the 2016 ECHO report and establish performance targets that use a standardized, government- defined, nutrient-profiling model across national borders and continents, accompanied by a timeline for expected outcomes. Strengthen voluntary industry self-regulatory programmes, support the monitoring of expenditure on – and practices in – the marketing of HFSSFBP and enable regulatory bodies to hold non-compliant companies accountable for young peoples’ exposure to such products – via all media platforms. Transnational industries Adopt the UNGC’s Responsible Business Practices and commit to clear goals and targets set by national governments to restrict young people’s exposure to branded HFSSFBP. Protect children and adolescents by not opposing government actions to implement strong legislation and regulation. Implement competitive business plans to reduce young people’s exposure to branded HFSSFBP, and shift marketing resources and product portfolios from such products towards nutrient-dense products, to help young people meet dietary targets. Demonstrate transparency and cooperation by sharing relevant information on websites and with independent monitoring bodies to monitor and evaluate progress made to restrict the marketing of HFSSFBP to young people within and across countries and globally. WHO headquarters and regional offices Support Member States by integrating the marketing of breast-milk substitutes, infant foods and HFSSFBP into a strong Code of Conduct, with long-term funding to support robust monitoring, reporting and accountability systems. Provide Member States with technical assistance to adopt a standardized, global nutrient-profiling model and to enact policies and legislation to restrict marketing of HFSSFBP to young people. Publish regular updates on the progress achieved by Member States to fully implement Resolution WHA63.14 by 2025. ECHO: Commission on Ending Childhood Obesity; HFSSFBP: high-fat, salty and/or sugary food and beverage products; UN: United Nations; UNGC: United Nations Global Compact; WHA: World Health Assembly; WHO: World Health Organization. Bull World Health Organ 2016;94:540–548| doi: http://dx.doi.org/10.2471/BLT.15.158667 545 Policy & practice Restricting the marketing of unhealthy foods and beveragesVivica I Kraak et al. uphold strong legislation. We need clear guidelines for the voluntary engagement of civil society and philanthropic orga- nizations with transnational industrial actors, via alliances and partnerships. We also need such organizations to: (i) use media-based advocacy to raise public awareness about the global costs of an unhealthy diet,50 to strengthen public support for restrictions on the marketing of unhealthy food and bev- erage products; (ii) conduct relevant monitoring and research; and (iii) ad- vocate for strong accountability systems that include financial penalties for non- compliant companies and industrial sectors that fail to protect young people from the marketing of unhealthy food and beverages.51 National governments Decision-makers in national govern- ment should set clear goals to restrict young people’s exposure to unhealthy branded food and beverage products, enact legislation and regulation in ac- cordance with Resolution WHA63.14 and establish performance targets – us- ing a government-defined, standard- ized nutrient-profiling system that applies across national borders and geographical areas and is accompanied by a defined timeline for expected out- comes. The decision-makers also need to allocate funding to: (i) establish or strengthen voluntary industrial self- regulatory programmes; (ii) support the monitoring of food and beverage mar- keting expenditures and practices; and (iii) enable regulatory bodies to hold non-compliant companies accountable for young people’s exposure, via all mar- keting practices and media platforms, to unhealthy food and beverage products.51 Transnational industrial actors The industrial actors should adopt a comprehensive global policy on re- sponsible marketing to children and adolescents that is accessible to all stakeholders in the public domain. The policy should include all forms of integrated marketing communications – e.g. company-owned, brand-equity mascots and licensed media charac- ters used on in-store food packaging and at points of sale, in-school food marketing, sponsorships, celebrity en- dorsements, charitable donations and fundraising activities.18,20,47 Industrial actors should also: (i) commit to clear targets set by national governments to restrict young people’s exposure to unhealthy branded food and bever- age products; (ii) use a government- approved nutrient-profiling system to guide the development of acceptable products; (iii) not oppose government actions to implement health-protecting legislation and regulation; (iv) design and implement competitive business plans to shift their marketing resources from unhealthy products to promote profitable but nutrient-dense products – and so help young people meet their recommended dietary targets for fruits and vegetables, whole grains and low- fat or non-fat dairy or dairy-substitute products; and (v) amend existing self- regulatory programmes to protect the diet and health of all individuals aged 18 years and younger. Finally, industrial actors must demonstrate transparency and share relevant information on their websites and with independent monitor- ing bodies, to facilitate the evaluation of progress to restrict the marketing of unhealthy food and beverage products to young people – within and across countries and globally. WHO WHO should support Member States by integrating the marketing of breast-milk substitutes, infant foods and unhealthy food and beverage products into a strong overarching Code of Conduct for the marketing of healthy foods and beverages – with long-term funding to support robust monitoring, reporting and accountability systems. WHO’s headquarters and its regional offices should provide Member States with technical assistance to adopt a standard- ized, global food and nutrient-profiling system, enact legislation and policies to restrict the marketing of unhealthy food and beverage products to young people, and publish regular updates on the progress that Member States are making towards the full implementation of Resolution WHA63.14 by 2025. Conclusion The five-year anniversary of Resolution WHA63.14 encourages us to reflect on the progress achieved and further actions required to protect young people from the harmful impacts of the marketing of unhealthy food and beverage products – especially given the rising prevalences of obesity and diet-related noncommunicable diseases worldwide. Several UN agencies offered useful leadership between 2010 and early 2016, by providing technical and policy guidance to Member States. How- ever, no Member State has implemented comprehensive legislation or enforced mandatory regulations to prohibit the marketing of unhealthy food and bev- erage products to young people. The Access to Nutrition Foundation 2016 scorecard has confirmed that transna- tional food and beverage firms have not yet implemented a global pledge, to engage in responsible marketing to young people, that covers all practices. Moreover, no industrial sector uses a standardized, government-supported nutrient profiling system to restrict the marketing of unhealthy food and bever- age products to those aged 14–18 years. Civil society organizations can develop model pledges to help Member States and industry accelerate progress. Na- tional governments and other relevant actors have future opportunities to build policy coherence across settings, sectors and continents and establish healthy food environments for young people. These actions should support the UN Convention on the Rights of the Child, the right to adequate nutrition, the reversal of the current upward trend in the prevalence of undernutrition, obe- sity and diet-related noncommunicable diseases, and the promotion of healthy lives for all by 2030. ■ Competing interests: None declared. Bull World Health Organ 2016;94:540–548| doi: http://dx.doi.org/10.2471/BLT.15.158667546 Policy & practice Restricting the marketing of unhealthy foods and beverages Vivica I Kraak et al. صخلم لافطلأل ةهجولما نوهدلا ةيلاعو ةلحالماو ةيركسلا تابوشرلماو ةيئاذغلا تاجتنلما قيوست صرح تاءارجإ في مدقتلا قيقتح مقر رارـقـلا دييأت 2010 ماـع نم راـيأ/وـياـم رهش دهش يذلاو ،ءاضعلأا لودلا نم ةلود 192 بناج نم WHA63.14 تابوشرلماو ةيئاذغلا تاجتنلما قيوست لىع دويقلا ضرفب ضيقي ،ةعبشلما نوهدلا نم ةيلاع بسن لىع يوتتح يتلا ةيلوحكلا يرغ لافطلأل حللما وأ/و ةرلحا تايركسلاو ،ةلوحتلما ةعبشلما نوهدلاو يتلا تاءارجلإا في انثحب دقلو .لماعلا ىوتسم لىع ينقهارلماو تماظنم لبق نم – 2016 ماع لئاوأو 2010 يماع ينب تذتخا ،ةيميلقلإا اهبتاكمو ةيلماعلا ةحصلا ةمظنمو ،نيدلما عمتجلما ،ةييرلخا تاسسؤلماو ،ةدحتلما مملأل ةعباتلا ىرخلأا تماظنلماو تلادعم نم فيفختلا في ةدعاسملل – ةينطولا برع تاعانصلاو يئاذغلا ماظنلاب ةلصلا تاذ ةيدعلما يرغ ضارملأاو ةنادبلا راشتنا تماظنلماو ةيلماعلا ةحصلا ةمظنم تدعاس دقو .راغصلا طاسوأ في قيوست رطامخ نم بابشلا ةياحم في ةدحتلما مملأل ةعباتلا ىرخلأا يتلاو ةيراجتلا تاملاعلا تاذ تابوشرلماو ةيئاذغلا تاجتنلما للاخ نم ،حللما وأ/و ركسلاو نوهدلا نم ةيلاع بسن لىع يوتتح .ءاضعلأا لودلل تاسايسلاب قلعتت ةينف تاودأو تاهيجوت ميدقت اهنع انيرتح يتلا ىرخلأا ةلعافلا فارطلأا هتزرحأ يذلا مدقتلا امأ .ماع لكشب ةيلاعف لقأو اًنيابتم ودبيف ققحلما مدقتلا ةيرتو نم عاسرلإا حترقن اننإف ،ددصلا اذه فيو ضرف قيرط نع WHA63.14 مقر رارقلل لماكلا ذيفنتلا هاتجاب يرغ تابوشرلماو ةيئاذغلا تاجتنلما قيوست لىع دويقلا نم ديزلما داولماب ةينغ تاجتنلم جيوترلا في رماثتسلاا قيرط نعو ،ةيحصلا .ةيذغلما فادهلأا قيقتح لىع راغصلا ةدعاسم هنأش نم رملأا اذه تايجيتاترسا يأ لىع يغبنيو .ةموكلحا نم ابه صىولما ةيئاذغلا ةيلماعلا ةحصلا ةمظنم فده عم ةيزاوتم نوكت نأ ةلاعف تاءارجإو % 25 ةبسنب ةيدعلما يرغ ضارملأا ببسب ةركبلما تايفولا نم دحلل شربلا عيجم عتتم نماضل ةدحتلما مملأا فدهو 2025 ماع لولحب .2030 ماع لولحب ةيحص ةايحب 摘要 限制向儿童推销高脂、高糖和高盐食品与饮料方面取得的进展 2010 年 5 月，192 个会员国通过了 WHA63.14 决议， 在全球范围内限制向儿童和青少年推销含有大量饱 和脂肪、反式脂肪酸、游离糖和 / 或盐的食品和非酒 精饮料。 我们对 2010 年至 2016 年初，民间社会组 织、世界卫生组织 (WHO) 及其地区办事处、其他联 合国 (UN) 机构、慈善机构和跨国性行业所采取的相 关措施进行了审查。这些措施旨在降低年轻人群的肥 胖症以及与膳食相关的非传染性疾病的发生率。 通过 向会员国提供相关技术、政策指导以及工具，世界卫 生组织 (WHO) 和其他联合国 (UN) 机构协助会员国限 制向年轻人群推销高脂肪、高糖和 / 或高盐的品牌食 品和饮料产品。 通过调查我们发现，其他活动方取得 的进展变数较大，且通常不够强劲。 我们建议可通 过进一步限制不健康食品和饮料的推销以及加大对高 营养产品的推广，加快推进全面贯彻 WHA63.14 决议 所取得的进展。 这将有助于年轻人群达到政府推荐 的膳食目标。 任何有效策略和措施均应该以世界卫 生组织 (WHO) 的目标为准——到 2025 年，将由非传 染性疾病导致的过早死亡率降低 25%，同时应符合联 合国 (UN) 的到 2030 年确保所有人过上健康生活的目 标。 Résumé Progrès réalisés pour restreindre la commercialisation d’aliments et de boissons riches en graisses, en sucre ou en sel destinés aux enfants En mai 2010, 192 États membres ont ratifié la Résolution WHA63.14 pour restreindre, à l’échelle internationale, la commercialisation des produits alimentaires et boissons non alcoolisées riches en graisses saturées, en acides gras trans, en sucres libres et/ou en sel, destinés aux enfants et aux adolescents. Nous avons étudié des initiatives d’organisations de la société civile, de l’Organisation mondiale de la Santé (OMS) et de ses bureaux régionaux, d’autres agences de l’Organisation des Nations unies (ONU), d’institutions philanthropiques et de groupes industriels internationaux, menées entre 2010 et début 2016 en vue d’aider à réduire la prévalence de l’obésité et des maladies non transmissibles liées à l’alimentation chez les jeunes. En fournissant aux États membres des outils et des conseils utiles en matière technique et pour l’adoption de mesures politiques, l’OMS et d’autres agences de l’ONU ont contribué à protéger les jeunes face à la commercialisation d’aliments et de boissons de marques, riches en graisses, en sucre et/ou en sel. Les résultats obtenus grâce aux initiatives des autres acteurs étudiés semblent variables et généralement moins solides. Nous suggérons d’accélérer les progrès accomplis vers la mise en œuvre complète de la Résolution WHA63.14, en restreignant davantage la commercialisation des aliments et boissons mauvais pour la santé et en investissant dans la promotion de produits denses sur le plan nutritionnel. Cela permettrait d’aider les jeunes à atteindre les objectifs nutritionnels recommandés par les gouvernements. Pour être efficaces, les stratégies et mesures adoptées doivent être cohérentes avec l’objectif de l’OMS visant à réduire la mortalité prématurée due aux maladies non transmissibles de 25% d’ici 2025 et avec l’objectif de l’ONU visant à permettre à tous de vivre en bonne santé d’ici 2030. Bull World Health Organ 2016;94:540–548| doi: http://dx.doi.org/10.2471/BLT.15.158667 547 Policy & practice Restricting the marketing of unhealthy foods and beveragesVivica I Kraak et al. Резюме Прогресс, достигнутый в ограничении сбыта пищевых продуктов и напитков с высоким содержанием жиров, сахара и соли детям В мае 2010 года 192 государства-участника поддержали Резолюцию WHA63.14, ограничивающую сбыт пищевых продуктов и безалкогольных напитков с высоким содержанием насыщенных жиров, трансжирных кислот, свободных сахаров и/или соли детям и подросткам во всем мире. Авторы проанализировали мероприятия, проведенные в период между 2010 годом и началом 2016 года группами гражданского общества, Всемирной организацией здравоохранения (ВОЗ) и ее региональными отделениями, другими организациями ООН, благотворительными учреждениями и транснациональными предприятиями. Эти мероприятия были нацелены на снижение распространенности ожирения и неинфекционных заболеваний, связанных с нарушением питания, среди молодых людей. Предоставив необходимые технические и стратегические руководящие указания и инструменты государствам-участникам, ВОЗ и другие организации ООН совершили вклад в защищенность молодых людей от сбыта фирменных пищевых продуктов и напитков с высоким содержанием жиров, сахара и/или соли. В результате исследования было обнаружено, что другие действующие субъекты достигли переменного и в целом менее устойчивого успеха. Авторы предполагают, что ускорить прогресс в плане выполнения Резолюции WHA63.14 во всех ее аспектах позволило бы дальнейшее ограничение сбыта нездоровых продуктов питания и напитков и инвестирование в популяризацию продуктов с высоким содержанием питательных веществ. Благодаря этому молодые люди смогут достичь целей в области питания населения, рекомендованных государством. Все эффективные стратегии и меры должны быть согласованы с целью ВОЗ снизить преждевременную смертность от неинфекционных заболеваний на 25% к 2025 году и целью ООН обеспечить здоровый образ жизни для всех к 2030 году. Resumen Progresos realizados en la limitación de la promoción de alimentos y bebidas con elevadas cantidades de grasa, azúcares y sal dirigida a los niños En mayo de 2010, 192 Estados Miembros aprobaron la Resolución WHA63.14 para limitar la promoción de alimentos y bebidas no alcohólicas con elevadas cantidades de grasas saturadas, ácidos grasos trans, azúcares libres y/o sal dirigida a los niños y adolescentes de todo el mundo. Se examinaron las medidas tomadas entre 2010 y principios de 2016 por parte de grupos de la sociedad civil, la Organización Mundial de la Salud (OMS) y sus sedes regionales, otras organizaciones de las Naciones Unidas, instituciones filantrópicas e industrias transnacionales para contribuir a la reducción de la prevalencia de la obesidad y enfermedades no contagiosas relacionadas con la alimentación entre los jóvenes. Mediante las directrices y herramientas políticas y técnicas correspondientes ofrecidas a los Estados Miembros, la OMS y otras organizaciones de las Naciones Unidas han ayudado a proteger a los jóvenes de la promoción de productos alimentarios y bebidas de marca con elevadas cantidades de grasa, azúcar y/o sal. Los progresos realizados por los otros participantes investigados parecen ser desiguales y, en general, menos sólidos. 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