Panel Talk

1. Panel Talk Barry Popkin Department of Nutrition, School of Public Health and Medicine,Department of Economics The University of North Carolina at Chapel Hill

2. Outline: Why is this occurring? Understand US and global farm policy: its long-term impact, and  current potential options with impact Understand what the food industry is considering and should/can do regarding  labeling and other options Understand the basis for price policy: what can we justify with current knowledge on price impact on overall diet. What will we gain from a soft drink tax?

3. Global Farm Policy Global focus: first on adequate grains for a country and then on increased animal source foods

4. Global Price Declines Oils, Livestock, Sugar • Agricultural experiment stations history • Major postWWII investments-infrastructure, credits, research, later subsidies • Mentality: solve grains, then livestock and ignore legumes, fruits and vegetables and minor coarse grains • DOHA round of trade talks: focus on subsidies EEU,US • Farm Bill past cycle, World Bank, other major global institutions

5. Price Policies Are a Great Option: Price Elasticities of Demand AIDS Demand Models Various Sources cited in Delgado & Courbois 1998; urban China 2000 figures from Yen, et al. 2004; S. Korea 1985 figures from Cranfield et al, 1998

6. Real World Prices, 1990 US$ 500 100 kg Beef 400 300 1 MT Maize 200 100 kg Poultry 100 90-92 70-72 80-82 94-96 2020 AIDS Demand Models Various Sources Cited in Delgado & Courbois 1998

7. China’s Accession into WTO • Eliminated quota & replaced with 10% tariff • Domestic edible oil production starting to compete with imports, halved number of factories, large transition underway leading to mainly modern large-scale factories. • Imports still very important & expected to rise • General decline in edible oil prices will accelerate with imports • Implications on demand seem to portend large increases in oil intake

8. Real Prices of Select Food Items from 1991-2004 in China yuan/kg Source: China Health and Nutrition Survey 1991 to 2004

9. Total Rich Poor The Effects of Changes in the Price of Edible Oil in China A. Change in the Proportion of Energy Due to a 10% Increase in Real Price of Edible Oils B. Demand Elasticity for Macronutrients Elasticity (% change in demand due to 10% increase in real price of edible oil) Change in the% of energy from macronutrients from a 10% increase in the price of edible oil Source: Ng et al (2008) SSM 66:414-426

10. Food Industry: Actions, Inactions, Deception • Self-monitoring: TV ads for kids in the US vs France, UK, Sweden, Brazil • Clinton-AHA-industry agreements: beverage one, no monitoring, regulations, slack standards vs. IOM • Smart Choices – new actions. • Mexico counterpart to see major differences

11. US Smart Choices Program—previously called Keystone Roundtable Food Industry members of keystone • Coca-Cola (USA) • Unilever • Wal-Mart • ConAgra Foods • General Mills • Grocery Manufacturers of America • Hannaford Bros. • Kellogg’s • Kraft Foods • National Dairy Council • Nestlé • Wakefern • Wegmans • Wrigley • PepsiCo

12. Aims of the Programme Help make healthy food choices easy for consumers Stimulate food industry towards healthy product innovation • Limit intake of nutrients with a negative impact on health • based on convincing evidence • Ensure intake of essential and beneficial nutrients such as dietary fibre • Promote appropriate energy intake

13. Need For Alignment • Proliferation of labels • Numerous front-of-pack symbols and icons • Little uniformity • Derived from different criteria, have various meanings • Concerns about potential confusion • Clutter the aisles and shoppers’ minds

14. 14

15. Nutrition CriteriaCategory-Specific • Nutrients to limit • Total fat, saturated fat, trans fat, cholesterol, added sugars, sodium (issues on added sugars cutoffs) • Nutrients to encourage • Calcium, potassium, fiber, magnesium, vitamin A, vitamin C, vitamin E (issues on types of fiber allowed to be counted, excessive allowance for added nutrients) • “Nutrients of concern” as identified in Dietary Guidelines for Americans • 10% Daily Value (“good” source) • Food groups to encourage • Fruits, vegetables, whole grains (problems), fat-free/low-fat dairy • Provide at least 1/2 serving as identified in Dietary Guidelines for Americans

16. Front of the Package Labeling United States Mexico Driven by gov’t, scholars but discuss with industry Whole grains only Health concerns-strict added sugar cutoffs Min of Finance, Food Standards, MOH run • Driven by industry with scholars mainly industry linked persons • Fiber including all types • Added sugar in cereals, beverages, high cutoff • voluntary

17. Understand the basis for price policy: What is justifiable now? Tobacco price changes through taxation at state, federal, even local levels Sugary beverages: similar rationale – no benefits, major health costs, major impact on others indirect What do we know

18. Mexico Initiative on Beverages • Remove all whole milk, shifted now to 1.5% and later to skim milk all gov’t programs • Schools: working to ban all sugar sweetened beverages, provide safe water, allow water, low fat milk to be sold • Taxation being considered: tax added sugars in beverages per gram, fat in milk • National media effort – began Feb 25 with launch of Mex. Beverage Guidelines • Source:Rivera et al, Salud Publica Mex 2008;50:173-195

19. Overall Poor Rich Effects of Price Changes on Soda and Whole milk Consumption 10% increase in the price of soda 10% increase in the price of whole milk Soda Whole milk Soda Whole milk

20. Limitations to Current Studies of Economic Predictors of Dietary Intake in the US • No studies examine the effects of food prices on individual dietary intake in the US except broad ecological relationships done in a cross-secitonal manner • Creation for CARDIA cohort of adults followed over 20 years food prices linked with the SMSA of each adult by our UNC team.. • Fairly detailed quantitative food frequency and clinical exam and fasting blood data • Focus on prices of beverages and fast foods here

21. $ % % Δ Δ kcals $ % % Δ Δ kcals Methods: Price Elasticity of Demand • Elasticity= % change in demand % change in price • Own-price elasticity • Cross-price elasticity Negative Negative or positive

22. Combined 10% Change in Price Results in Greater Percent Change in Outcomes: 20 year longitudinal analysis of price and CARDIA cohort Percent Change in outcome Source: Duffey et al, manuscript 2009 not for distribution/use

23. Summary • Prices of soda and pizza were important • predictors of consumption • associated with changes in total energy, body weight, and HOMA-IR • Similar relationships for whole milk, hamburgers, and orange juice not observed

24. Economic policies might work • Examples (China, Mexico, the United States) show the potential • However no examples exist for unhealthy foods taxed for healthy reasons with any linkage to diet or other measures of health • Tobacco is the prime example

25. 25 JUN THURSDAY United :947 Ams-Dulles 1220P– 247P UNITED 107 DULLES -RDU 515P– 624P THE BOOK “The most serious epidemic ever is insidiously engulfing the world. Barry Popkin draws upon his decades of research and experience to describe its origins–and a set of potential solutions. Those interested in the future of mankind should read this book.” Walter Willett, author of Eat, Drink, and Be Healthy, and chair, Department of Nutrition, Harvard University