Health policy implications of corporate social responsibility provisions in international investment agreements.

Objective: To analyse and classify inclusions of corporate social responsibility in international investment agreements, especially inclusions with reference to public health. Method: We extracted the text of international investment agreements containing corporate social responsibility inclusions from the Electronic Database of Investment Treaties. We conducted a documentary analysis of the corporate social responsibility inclusions, and we developed a typology categorizing inclusions based on level of detail and reference to international commitments. Findings: Of the 3816 agreements signed as of October 2023, 127 agreements contain corporate social responsibility inclusions. Since the first inclusion of corporate social responsibility in 2008, the percentage of agreements containing such inclusion signed each year has steadily increased from 4.6% (4/86) in 2008 to 42.8% (21/49) in 2018 and 33.3% (3/9) in 2023. Using the typology we developed, we categorized the level of detail as follows: nine were minimal, 27 were low, 35 were low-medium, 107 were medium, 11 were medium-high and seven were high. Health is mentioned in 36 of these inclusions. Conclusion: This analysis indicates that international investment agreements increasingly incorporate a high level of detail on expectations regarding investors' corporate social responsibility. Such provisions offer a potential tool to increase government guidance and accountability of global corporations, including with respect to governments' public health objectives.

A narrative review of online food delivery in Australia: challenges and opportunities for public health nutrition policy.

OBJECTIVE: Online food delivery (OFD) platforms offer consumers a convenient and fast delivery service of foods and drinks sourced from foodservice partners (e.g. restaurants, quick service restaurants). There is a need to assess the impact of this emergent segment of the foodservice sector on diet and diet-related health. The aim of this narrative review was to describe the OFD sector in Australia, its use and identify potential ways to include OFD platforms in existing public health nutrition policy. DESIGN: A search was conducted in peer-reviewed and grey literature. Sources were analysed and synthesised to report the characteristics of OFD platforms, delivery process, users and potential drivers of usage. The aim and scope of public health nutrition policies were analysed to identify ways of including OFD platforms. SETTING: Australia. PARTICIPANTS: General population. RESULTS: There are three main operators with 9000-16 000 foodservice partners based predominantly in the main cities of Australia. OFD revenue has grown by 72 % in the last 5 years and is predicted to increase driven by usage by working adults with high disposable income who demand convenience. Current policies and initiatives aimed at manufacturers, retailers and foodservice outlets do not specifically regulate OFD platforms, although there is scope for these to be extended to such platforms. CONCLUSIONS: OFD platforms are disruptors of the foodservice sector. Innovative and consistent health policy options that target the unique challenges and opportunities posed by OFD platforms are required to limit the potentially negative impact of OFD platforms on diet and diet-related health.

A Scoping Review of Citizen Science Approaches in Chronic Disease Prevention.

Background: Citizen science approaches, which involve members of the public as active collaborators in scientific research, are increasingly being recognized for their potential benefits in chronic disease prevention. However, understanding the potential applicability, feasibility and impacts of these approaches is necessary if they are to be more widely used. This study aimed to synthesize research that has applied and evaluated citizen science approaches in chronic disease prevention and identify key questions, gaps, and opportunities to inform future work in this field. Methods: We searched six databases (Scopus, Medline, Embase, PsycInfo, PubMed, and CINAHL) in January 2022 to identify articles on the use of citizen science in prevention. We extracted and synthesized data on key characteristics of citizen science projects, including topics, aims and level of involvement of citizen scientists, as well as methods and findings of evaluations of these projects. Results: Eighty-one articles reported on citizen science across a variety of health issues, predominantly physical activity and/or nutrition. Projects primarily aimed to identify problems from the perspective of community members; generate and prioritize solutions; develop, test or evaluate interventions; or build community capacity. Most projects were small-scale, and few were co-produced with policy or practice stakeholders. While around half of projects included an evaluation component, overall, there was a lack of robust, in-depth evaluations of the processes and impacts of citizen science projects. Conclusions: Citizen science approaches are increasingly being used in chronic disease prevention to identify and prioritize community-focused solutions, mobilize support and advocacy, and empower communities to take action to support their health and wellbeing. However, to realize the potential of this approach more attention needs to be paid to demonstrating the feasibility of using citizen science approaches at scale, and to rigorous evaluation of impacts from using these approaches for the diverse stakeholders involved.

Identifying Opportunities for Strategic Policy Design to Address the Double Burden of Malnutrition through Healthier Retail Food: Protocol for South East Asia Obesogenic Food Environment (SEAOFE) Study.

Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers' and retailers' perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context.

Drawing on Strategic Management Approaches to Inform Nutrition Policy Design: An Applied Policy Analysis for Salt Reduction in Packaged Foods.

BACKGROUND: Nutrition policies to improve the food environment frequently rely on voluntary business action for implementation, many have had mixed success. The aims of this study were to identify key food system drivers influencing the Australian packaged food sector and analyse how these might impact the willingness of food companies to voluntarily reduce salt in packaged foods. METHODS: Business methods formed the basis of this retrospective applied policy analysis of voluntary salt reduction for the period 2013-2016 where the focal policy was the Australian Food and Health Dialogue (2009-2015). The analytical framework included political-legal, economic, social, technological (PEST) external drivers of the food system, and Porter's Five Forces for the competitive drivers of the food system. Documentary data identifying food system drivers affecting the Australian packaged food sector (comprised of the food processing and supermarket industries) were identified through a comprehensive search of the grey and academic literatures. RESULTS: The interplay between external and competitive food system drivers created an environment in which voluntary salt reduction was found to be an uneasy fit. A high cost of doing business, soft growth, intense competition, asymmetry of power in favour of supermarkets, and marginal consumer interest in less salty food were found likely to create commercial disincentives to invest in voluntary salt reduction above more pressing commercial imperatives. Analysis of food manufacturing industries highlighted the highly contextual nature of food system drivers. Opportunities for nutrition policy included: support for 'shared value' in economic discourse; and, leveraging investor, supermarket, and the largely unrealised bargaining power of consumers. CONCLUSION: Business frameworks can provide meaningful insights for nutrition policy on how food system drivers can thwart policy goals. Our analysis highlighted areas to incentivise voluntary action and illustrated the importance of political-legal, economic and consumer strategies for salt reduction.

COVID-19 and Pacific food system resilience: opportunities to build a robust response.

The unfolding COVID-19 pandemic has exposed the vulnerability of the Pacific food system to externalities and has had far-reaching impacts, despite the small number of COVID-19 cases recorded thus far. Measures adopted to mitigate risk from the pandemic have had severe impacts on tourism, remittances, and international trade, among other aspects of the political economy of the region, and are thus impacting on food systems, food security and livelihoods. Of particular concern will be the interplay between loss of incomes and the availability and affordability of local and imported foods. In this paper, we examine some of the key pathways of impact on food systems, and identify opportunities to strengthen Pacific food systems during these challenging times. The great diversity among Pacific Island Countries and Territories in their economies, societies, and agricultural potential will be an important guide to planning interventions and developing scenarios of alternative futures. Bolstering regional production and intraregional trade in a currently import-dependent region could strengthen the regional economy, and provide the health benefits of consuming locally produced and harvested fresh foods - as well as decreasing reliance on global supply chains. However, significant production, processing, and storage challenges remain and would need to be consistently overcome to influence a move away from shelf-stable foods, particularly during periods when human movement is restricted and during post-disaster recovery.

The Effects of a Supermarket-Based Intervention on the Nutritional Quality of Private-Label Foods: A Prospective Study.

Private-label products, products owned by supermarkets, are a growing area of the food supply. The aim of this study was to assess the effect of an intervention that provided an Australian supermarket ('intervention supermarket') with comparative nutrition data to improve the healthiness of their private-label range. Between 2015 and 2016, the intervention supermarket received reports that ranked the nutritional quality of their products against competitors. Changes in the nutrient content (sodium, sugar, saturated fat, energy and Health Star Rating) of products from the intervention supermarket between 2015 and 2018 were compared against changes achieved for three comparators (private-label products from two other supermarkets and branded products). The intervention supermarket achieved a significantly greater reduction in the sodium content of their products relative to all three comparators, which ranged between -104 and -52 mg/100 g (all p < 0.05). Conversely, the three comparators each achieved a greater relative reduction in the sugar content of their products by between -3.5 and -1.6 g/100 g (all p < 0.05). One of the comparators also had a greater relative reduction in the saturated fat and energy content of their products compared to the intervention supermarket (both p <0.05). There were negligible differences in the Health Star Rating of products between the intervention supermarket and comparators (all p > 0.05). Providing comparative nutrition information to a supermarket may be ineffective in improving the healthiness of their private-label products, likely due to competing factors that play a role in the decision-making process behind product reformulation and product discontinuation/innovation.

Private food safety standards in the global food supply chain: a scoping review protocol.

OBJECTIVE: The objective of this review is to examine and map the reported forms, process functions, and objectives associated with private food safety standards to draw conclusions for public health nutrition. INTRODUCTION: One pressing public health nutrition issue is the need for a healthier food supply to reduce diet-related risk factors for non-communicable diseases. Many organizations are involved in private food safety and/or nutrition standards that govern their food supply. With few published data on private nutrition standards, understanding the motivations behind enacting private food safety standards as a means of gaining authority may elucidate strategic opportunities of interest for the public health nutrition audience. This could positively affect the use of private standards and nutritional quality of packaged foods. INCLUSION CRITERIA: Articles to be considered must focus on private food safety standards, which principally relate to the supply chain of packaged food for retail sale, in any country. In this group, the standard is largely invisible to consumers, and the dominant actors are private firms. Concepts of interest are the evolution, key drivers, regulatory form, function, objective and incentive for involvement in standard setting, adoption, implementation, conformity and enforcement of private food safety standards. METHODS: An extensive search of multiple databases and official websites to source gray literature will be undertaken to identify articles of any design, reports and conference proceedings in English from 2008 to present. Selection, screening and data synthesis will follow JBI methodology. Data extraction will be undertaken using an extraction tool developed for this scoping review.

Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action.

The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, we describe the evidence base for diet-related interventions based on fiscal policies and consider the key questions that need to be asked by both health and economic policy-makers. From the health sector's perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. We highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions.

L'Organisation mondiale de la Santé a recommandé aux États membres d'envisager de taxer les boissons et aliments à haute teneur énergétique et/ou de subventionner les denrées riches en nutriments, en vue d'améliorer les régimes alimentaires et de prévenir les maladies non transmissibles. Aujourd'hui, nombreux sont les pays à avoir instauré des taxes sur les boissons et aliments à haute teneur énergétique ou à envisager de le faire. Néanmoins, d'importants défis subsistent pour la mise en application de ce type de politiques fiscales. Certains sont liés à la nature intersectorielle des interventions appropriées. Par exemple, comme les responsables des politiques économiques et les responsables des politiques de santé ont des préoccupations administratives, des priorités et des indicateurs de performances différents, ils s'appuient souvent sur différentes formes de données dans leur prise de décisions. Dans le présent document, nous décrivons les données probantes susceptibles d'orienter les interventions sur l'alimentation fondées sur des politiques fiscales et nous évoquons les principales problématiques auxquelles doivent répondre à la fois les responsables des politiques économiques et les responsables des politiques de santé. D'un point de vue de santé publique, les preuves de l'impact des taxes et subventions sur les habitudes alimentaires sont plus nombreuses que les preuves de leur impact sur le poids ou la santé. Nous abordons également l'importance du périmètre d'action, le rôle de l'industrie, l'utilisation des recettes fiscales et la régressivité des taxes, dans l'optique d'éclairer les décisions politiques.

La Organización Mundial de la Salud ha recomendado a los Estados Miembros considerar la posibilidad de aplicar un impuesto a las bebidas y los alimentos de alto contenido energético y/o subvencionar los alimentos ricos en nutrientes para mejorar las dietas y prevenir enfermedades no contagiosas. Numerosos países ya aplican impuestos a bebidas y alimentos de alto contenido energético o consideran la implementación de dichos impuestos. Sin embargo, persisten varios desafíos importantes para la implementación de políticas fiscales para mejorar las dietas y prevenir las enfermedades no contagiosas. Algunos de estos desafíos están relacionados con la naturaleza intersectorial de las intervenciones correspondientes. Por ejemplo, puesto que los encargados de la formulación de políticas de salud y economía tienen diferentes preocupaciones administrativas, indicadores de rendimiento y prioridades, a menudo tienen en cuenta diferentes formas de pruebas en su toma de decisiones. En este documento, se describe la base de pruebas para intervenciones relacionadas con la dieta basadas en políticas fiscales y se consideran las preguntas clave que deben formular tanto los responsables de la política económica como de la de salud. Desde la perspectiva del sector de la salud, existen muchas pruebas del impacto de los impuestos y subsidios en las dietas, con menos pruebas de sus impactos sobre el peso o la salud corporal. Se destaca la importancia del alcance, el papel de la industria, el uso de los ingresos y los impuestos regresivos para informar sobre las decisiones políticas.

Effects of an Advocacy Trial on Food Industry Salt Reduction Efforts-An Interim Process Evaluation.

The decisions made by food companies are a potent factor shaping the nutritional quality of the food supply. A number of non-governmental organizations (NGOs) advocate for corporate action to reduce salt levels in foods, but few data define the effectiveness of advocacy. This present report describes the process evaluation of an advocacy intervention delivered by one Australian NGO directly to food companies to reduce the salt content of processed foods. Food companies were randomly assigned to intervention (n = 22) or control (n = 23) groups. Intervention group companies were exposed to pre-planned and opportunistic communications, and control companies to background activities. Seven pre-defined interim outcome measures provided an indication of the effect of the intervention and were assessed using intention-to-treat analysis. These were supplemented by qualitative data from nine semi-structured interviews. The mean number of public communications supporting healthy food made by intervention companies was 1.5 versus 1.8 for control companies (p = 0.63). Other outcomes, including the mean number of news articles, comments and reports (1.2 vs. 1.4; p = 0.72), a published nutrition policy (23% vs. 44%; p = 0.21), public commitment to the Australian government's Food and Health Dialogue (FHD) (41% vs. 61%; p = 0.24), evidence of a salt reduction plan (23% vs. 30%; p = 0.56), and mean number of communications with the NGO (15 vs. 11; p = 0.28) were also not significantly different. Qualitative data indicated the advocacy trial had little effect. The absence of detectable effects of the advocacy intervention on the interim markers indicates there may be no impact of the NGO advocacy trial on the primary outcome of salt reduction in processed foods.

Completeness of nutrient declarations and the average nutritional composition of pre-packaged foods in Beijing, China.

Increasing consumption of pre-packaged foods is likely an important driver of diet-related diseases in China. From January 2013 it became mandatory to provide a standardised nutrient declaration on pre-packaged foods in China. We collected data on pre-packaged foods from large chain supermarkets in Beijing in 2013, examined the completeness of the nutrient declaration of core required nutrients and summarised the average nutritional composition of 14 different major food groups. We also illustrated the potential use of the data by comparing sodium levels. Photos of 14,279 pre-packaged foods were collected from 16 chain supermarkets in Beijing. Data for 11,489 products were included in the evaluation of nutrient declarations and data for 10,048 in the summary analysis of average nutritional composition. Compliant nutrient declarations were displayed by 87% of products with 88% of foods displaying data for each of energy, protein, total fat, carbohydrate and sodium. Nutrients not required by the Chinese regulation were infrequently reported: saturated fat (12%), trans fat (17%) and sugars (11%). Mean sodium levels were higher in Chinese products compared to UK products for 8 of 11 major food categories, often markedly so (e.g. 1417 mg/100 g vs. 304 mg/100 g for convenience foods). There has been substantial uptake of the recently introduced Chinese nutrition labelling regulation which should help consumers to choose healthier foods. As the comparison against corresponding data about sodium from the United Kingdom shows, the nutrient data can also be used to identify broader opportunities for improvement of the food supply.

High variation in manufacturer-declared serving size of packaged discretionary foods in Australia.

Despite the potential of declared serving size to encourage appropriate portion size consumption, most countries including Australia have not developed clear reference guidelines for serving size. The present study evaluated variability in manufacturer-declared serving size of discretionary food and beverage products in Australia, and how declared serving size compared with the 2013 Australian Dietary Guideline (ADG) standard serve (600 kJ). Serving sizes were obtained from the Nutrition Information Panel for 4466 packaged, discretionary products in 2013 at four large supermarkets in Sydney, Australia, and categorised into fifteen categories in line with the 2013 ADG. For unique products that were sold in multiple package sizes, the percentage difference between the minimum and the maximum serving size across different package sizes was calculated. A high variation in serving size was found within the majority of food and beverage categories - for example, among 347 non-alcoholic beverages (e.g. soft drinks), the median for serving size was 250 (interquartile range (IQR) 250, 355) ml (range 100-750 ml). Declared serving size for unique products that are available in multiple package sizes also showed high variation, particularly for chocolate-based confectionery, with median percentage difference between minimum and maximum serving size of 183 (IQR 150) %. Categories with a high proportion of products that exceeded the 600 kJ ADG standard serve included cakes and muffins, pastries and desserts (≥74 % for each). High variability in declared serving size may confound interpretation and understanding of consumers interested in standardising and controlling their portion selection. Future research is needed to assess if and how standardising declared serving size might affect consumer behaviour.

Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods.

BACKGROUND: Corporate decisions affecting the composition of processed foods are a potent factor shaping the nutritional quality of the food supply. The addition of large quantities of salt to foods is incompatible with Australian Dietary Guidelines and the reformulation of processed foods to have less salt is a focus of non-governmental organisations (NGOs). There is evidence that advocacy can influence corporate behaviour but there are few data to define the effects of NGOs working in the food space. The aim of this study is to quantify the effects of advocacy delivered by a local NGO on the salt content of food products produced or marketed by companies in Australia. METHODS/DESIGN: This is a cluster-randomised controlled trial that will be done in Australia from 2013 to 2015 which includes 45 food companies. The 23 companies in the control group will receive no specific intervention whilst the 22 companies in the intervention group will receive an advocacy program based upon an established theory of change model. The primary outcome will be the mean change in sodium content (mg/100 g) of processed foods produced or marketed by intervention compared to control companies assessed at 24 months. Interim outcomes (statements of support, published nutrition policies, level of engagement, knowledge and use of technology to reduce salt, salt reduction plans, and support for national initiatives) will also be assessed and a qualitative evaluation will provide more detailed insight. DISCUSSION: This novel study will provide robust randomised evidence about the effects of advocacy on food company behaviour and the quality of the processed food supply. A finding of improved food company behaviour will highlight the potential for greater investment in advocacy whilst the opposite result will reinforce the importance of government-led initiatives for the improvement of the food supply. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02373423. 26/02/2015.

A Comparison of the Sodium Content of Supermarket Private-Label and Branded Foods in Australia.

Supermarket private-label products are perceived to be lower quality than their branded counterparts. Excess dietary sodium in foods contributes to high blood pressure and cardiovascular disease. Sodium concentrations in products are an important indicator of quality. We compared the sodium content of 15,680 supermarket private-label and branded products, available in four Australian supermarkets between 2011-2013, overall and for 15 food categories. Mean sodium values were compared for: (1) all products in 2013; (2) products in both 2011 and 2013; and (3) products only in 2013. Comparisons were made using paired and unpaired t tests. In each year the proportion of supermarket private-label products was 31%-32%, with overall mean sodium content 17% (12%-23%) lower than branded products in 2013 (p ≤ 0.001). For products available in both 2011 and 2013 there was a ≤2% (1%-3%) mean sodium reduction overall with no difference in reformulation between supermarket private-label and branded products (p = 0.73). New supermarket private-label products in 2013 were 11% lower in sodium than their branded counterparts (p = 0.02). Supermarket private-label products performed generally better than branded in terms of their sodium content. Lower sodium intake translates into lower blood pressure; some supermarket private-label products may be a good option for Australians needing to limit their sodium intake.

Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia.

Despite tremendous growth in the consumption of gluten-free (GF) foods, there is a lack of evaluation of their nutritional profile and how they compare with non-GF foods. The present study evaluated the nutritional quality of GF and non-GF foods in core food groups, and a wide range of discretionary products in Australian supermarkets. Nutritional information on the Nutrition Information Panel was systematically obtained from all packaged foods at four large supermarkets in Sydney, Australia in 2013. Food products were classified as GF if a GF declaration appeared anywhere on the product packaging, or non-GF if they contained gluten, wheat, rye, triticale, barley, oats or spelt. The primary outcome was the 'Health Star Rating' (HSR: lowest score 0.5; optimal score 5), a nutrient profiling scheme endorsed by the Australian Government. Differences in the content of individual nutrients were explored in secondary analyses. A total of 3213 food products across ten food categories were included. On average, GF plain dry pasta scored nearly 0.5 stars less (P< 0.001) compared with non-GF products; however, there were no significant differences in the mean HSR for breads or ready-to-eat breakfast cereals (P≥ 0.42 for both). Relative to non-GF foods, GF products had consistently lower average protein content across all the three core food groups, in particular for pasta and breads (52 and 32% less, P< 0.001 for both). A substantial proportion of foods in discretionary categories carried GF labels (e.g., 87% of processed meats), and the average HSR of GF discretionary foods were not systematically superior to those of non-GF products. The consumption of GF products is unlikely to confer health benefits, unless there is clear evidence of gluten intolerance.

'Sustainability does not quite get the attention it deserves': synergies and tensions in the sustainability frames of Australian food policy actors.

OBJECTIVE: The development of food policy is strongly influenced by the understanding and position actors adopt in their 'framing' of sustainability. The Australian Government developed a National Food Plan (2010-2013). In public consultations on the National Food Plan Green Paper, the government sought stakeholders' views on sustainability. The present study examined the way in which the food industry and civil society organizations framed sustainability in their submissions to the Green Paper. DESIGN: Submissions by food industry actors and civil society organizations were analysed using a framing matrix that examined positioning, drivers, underlying principles and policy solutions related to sustainability. Submissions were open coded and subsequently organized based on themes within the framing matrix. SETTING: Australia. SUBJECTS: One hundred and twenty-four written submissions (1420 pages). RESULTS: While submissions from industry and civil society organizations often framed sustainability similarly, there were also major differences. Civil society organizations were more likely to make the link between the food supply and population health, while industry was more likely to focus on economic sustainability. Both viewed consumer demand as a driver of sustainability, welcomed the idea of a whole-of-government approach and stressed the need for investment in research and development to improve productivity and sustainable farming practices. CONCLUSIONS: The meaning of sustainability shifted throughout the policy process. There are opportunities for creating shared value in food policy, where the health, environment and economic dimensions of sustainability can be compatible. However, despite pockets of optimism there is a need for a shared vision of sustainability if Australia is to have a food policy integrating these dimensions.

An evaluation of the effects of the Australian Food and Health Dialogue targets on the sodium content of bread, breakfast cereals and processed meats.

The Australian Food and Health Dialogue set sodium reduction targets for three food categories (breads, ready-to-eat breakfast cereals and processed meats) to be achieved by December, 2013. Sodium levels for 1849 relevant packaged foods on the shelves of Australian supermarkets between 2010 and 2013 were examined. Changes in mean sodium content were assessed by linear mixed models, and the significance of differences in the proportion of products meeting targets was determined using chi-squared or McNemar's tests. The mean sodium level of bread products fell from 454 to 415 mg/100 g (9% lower, p < 0.001), and the proportion reaching target rose from 42% to 67% (p < 0.005). The mean sodium content of breakfast cereals also fell substantially from 316 to 237 mg/100 g (25% lower, p < 0.001) over the study period. The decline in mean sodium content of bacon/ham/cured meats from 1215 to 1114 mg/100 g (8% lower, p = 0.001) was smaller, but associated with a rise in the proportion meeting the target from 28% to 47%. Declines in mean sodium content did not appreciably differ between companies that did and did not make public commitments to the targets. These data show that the Australian food industry can reduce salt levels of processed foods and provide a strong case for broadening and strengthening of the Food and Health Dialogue (FHD) process.