We developed the NOURISHING framework to highlight where governments need to take action to promote healthy diets and reduce overweight and obesity.
The framework is accompanied by a regularly updated database (last updated 24 October 2018), providing an extensive overview of implemented government policy actions from around the world.
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The evidence suggests people who want to eat well use nutrient lists to choose healthier options. Interpretative labels help them when they find the labels hard to understand. Nutrition labels also create incentives for food manufacturers to reformulate their products, so helping populations more broadly by increasing the availability of food of higher nutritional value.
Clear standards are also needed on the use of nutrient and health claims. Evidence shows these claims alter the perception people have of these products – making it essential that they do not mislead.
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The Food Safety Act 2009 in Fiji and the Pure Food (Food Control) Regulations 2009 in the Solomon Islands require on-shelf labelling for canned luncheon meat, canned meat containing other food that has more than 20% fat, and for all minced meats and sausages sold unpackaged. The label should read "This brand of canned luncheon meat/canned meat with (name of the other food) is high in fat. For a healthy diet eat less". It is reported to not be widely implemented.
We know from the evidence that making fruit and vegetables available in schools increases consumption. There is also evidence that food standards to restrict availability have the effect of reducing consumption of the restricted food.
For these actions to be effective for all children, they need to be sustained over time and accompanied by complementary behaviour change communication techniques, such as "modelling", school gardens, and communication to all stakeholders involved in the provision and consumption of school food. Worksites and healthcare also present strong potential for improved eating among adults.
The Ministry of Education’s Food and Nutrition Policy requires all school canteen operators to comply with Fiji’s School Canteen Guidelines, developed by the National Food and Nutrition Centre in 2005 and revised in 2013. The guidelines outline how to prepare and provide healthy “everyday” food with recipes and nutrition guidelines. They are enforced by the Ministry of Education.
Empirical estimates show that food prices influence, to a varying degree, how much food people buy. Targeted subsidies have been shown to help overcome affordability barriers to healthy food for people on low incomes. Incentives, like financial rewards or price discounts, have also been shown to encourage people to switch to healthier options.
Emerging evidence from implemented taxes, as well as modelling studies, indicate the potential for effectiveness to reduce consumption. Given food choices are influenced by a whole host of factors, especially in modern, complex food markets, taxes must be designed very carefully to maximise effectiveness.
Please note, $ refers to USD.
In the mid-year budget of 23 June 2016, Fiji raised the excise duty on locally produced sweetened beverages from 10 Fijian cents per litre (around $0.05 per litre) to 30 cents per litre (around $0.15 per litre). In August 2017, the excise duty was further raised to 35 cents per litre (around $0.17 per litre). Imported sweetened beverages are subject to an ad valorem excise duty of 15% (raised from 10% in 2011), and imported powders and preparations to make beverages (other than milk-based drinks) as well as flavoured and coloured sugar syrups are taxed at 10% since 2007. Taxed beverages include carbonated and non-carbonated drinks sweetened with sugar or artificial sweeteners. The tax increase aims to protect children from obesity and lifelong poor health. Tax revenue goes to the general fund.
These countries have all introduced import duties on either soft drinks or sugar; Nauru also taxes high-sugar food. These are either charged ad valorem (Cook Islands – 15% with a subsequent 2% rise per year, since 2013; Fiji – 32%, since 2011; Micronesia – 25%, since 2004; Nauru – 30%, since 2007) or on a certain volume or weight of goods (French Polynesia – around $0.68 per litre for imported drinks, since 2002; Samoa – around $0.17 per litre, since 2008).
Thow AM et al. (2010) Taxing soft drinks in the Pacific: implementation lessons for improving health. Health Promotion International 26(1), 55-64
In 2012, Fiji implemented an import duty on palm oil and monosodium glutamate of 32%.
To promote vegetable and fruit consumption, Fiji has removed the excise duty on imported fruits, vegetables and legumes. It has also decreased the import tax for most varieties from the original 32% to 5% (exceptions: 32% import tax remains on tomatoes, cucumbers, potatoes, squash/pumpkin; and 15% on coconuts, pineapples, guavas, mangosteens) and removed it for garlic and onions.
We are all influenced by the food that is available and affordable when we grow up, and the habits of the people around us. That’s why people in different countries and communities consume differently. We know that when the food supply changes, so does what people eat. This is why we need to improve the quality of the food supply. Evidence from salt reduction indicates that people’s tastes can change.
In 2000, Fiji introduced a sales ban on mutton flaps, which have very high fat and very low meat content.
Awareness is one precursor to eating well. The evidence suggests that public campaigns can boost awareness. To influence consumption, they need to be sustained and use multiple channels.
Food-based dietary guidelines are an information and communication tool involving the translation of recommended nutrient intakes or population targets into recommendations of the balance of food that populations should be consuming for a healthy diet. They typically promote increased intake of fruit and vegetables and limited intake of salt/sodium and sugar. They may also include guidance on physical activity and healthy weight, and provide guidelines for different population groups. Countries use various formats of presenting the guidelines including cooking pots (Guatemala, Paraguay), pineapples (Fiji), pyramids (Australia, India, US), plates (Colombia, UK), pagodas (China), spinning top (Venezuela), traditional African house (Benin) and circles (Argentina). Some countries have started to include sustainability criteria in their dietary guidelines (eg Germany in 2013, Finland and Brazil in 2014, Sweden and Qatar in 2015, the Netherlands and UK in 2016). Brazil’s revised dietary guidelines, launched in 2014, present food- and meal-based recommendations that take into account cultural dimensions and promote the consumption of minimally processed food as well as health, wellbeing and sustainable food systems, and recommend avoiding ultra-processed food. Details on the content of national dietary guidelines can be found on the FAO database on Food-based dietary guidelines.
People with elevated risk factors for cancer and other non-communicable diseases – such as heavy bodyweight, high cholesterol or glucose intolerance – can benefit from advice provided by their healthcare provider. Such advice can also be given to people at low risk for prevention into the future.
There is potentially a wide range of mechanisms for integrating nutrition advice into primary care, including counselling, self-help materials and computer-tailored messages. Randomised controlled trials suggest they can be effective if carefully designed and well targeted. The most positive outcomes appear to be for people already at risk.
Fiji’s Ministry of Health, assisted by Diabetes Fiji, have established three Diabetes Hub Centres in Labasa, Lautoka and Suva. Following diagnosis, patients are referred to a Diabetes Hub Centre, which are set up with a team to provide a "one stop shop" for diabetes care, including dietitians who provide nutrition advice.