November 2013 Policies to Reduce Sodium Consumption and Eliminate Trans Fats in Argentina.

Chronic non-communicable diseases (CNCD) and prevalence of risk factors in Argentina. Source: National Survey of Risk Factors 2005 and % Of deaths can be attributed to CNCD* *Source: WHO- Source: Ministry of Health 76% Of DALY can be attributed to CNCD* 33% Of deaths attributed to cardiovascular diseases. They represent the 1° cause of death 21% Of the deaths attributed to cancer. It represents the 2° cause de death

Salt Consumption in Argentina Source: National Survey of Risk Factors 2005 and Grams per day is the consumption of sodium per person in Argentina 5 Grams per day is the consumption of sodium recommended (WHO) 4 Grams per day comes from bread 60% of salt ingested comes from processed foods Source: Ministry of Helath ¿Do you always/almost always add salt to the food after it was cooked?

2009 National Strategy for Prevention and Control of Non-communicable Chronic Diseases (Ministry of Health Resolution N° 1083/09) Actions that promote healthy diet Less Salt, More Life Argentina 2014, Free from Trans Fat Both strategies are accompanied by campaigns that promote fruit and vegetable consumption and physical activity.

Elimination of Trans Fat and Reduction of sodium: Background. Trans Fat (TF) 1. Its consumption ↑ the risk of coronary disease and diabetes. 2. There are technically and economically feasible procedures to replace them 3. ↓ 2% in consumption of TF would avoid between and cases of ischemic heart disease each year in México, Centroamerica and South America. Sodium 1. ↑ risk of cardiovascular diseases and hypertension. 2. ↑ risk of stroke- cardiac hypertrophy- proteinuria and renal disease 3. Obesity, stomach cancer- osteoporosis-nephrolithiasis- aggravation of asthma.

Elimination of Trans Fat and Reduction of sodium IMPLEMENTED ACTIONS INTER-SECTORAL APPROACH Ministry of Health called different sectors involved in the regulation, production and distribution of food to agree on joint actions to eliminate trans fats and reduce sodium consumption. National Commission to Eliminate Trans Fats and Reduce Salt -Ministry of Health -Ministry of Agriculture, Livestock and Fishing -National Institute of Industrial Technology(INTI) -National Food Institute (INAL) -Ministry of Social Development -Ministry of Science and Technology -Ministry of Economy -Coordinator for Food Product Industries (COPAL) -Argentinean Federation of Baked Products Industries (FAIPA) -Argentinean Association of Fats and Oils (ASAGA) -Universities and scientific societies -Business Chambers -Cooperative workers -Consumer associations

Argentina 2014 Free from Trans Fat Trans Fat Regulation - Regulation -Dissemination of information to small and medium industries (Guidelines) -Campaigns for consumers - Regulation -Dissemination of information to small and medium industries (Guidelines) -Campaigns for consumers Elimination of Trans Fat and Reduction of sodium: IMPLEMENTED ACTIONS RESULT: Amendment of the Food Code article Nº 155 tri, Chapter II of The Argentine Food Code Less salt, More life Sodium Self-Regulation -Voluntary agreements with the industry -Reduction of salt content in artisanal bread -Public awareness on the need to lower salt intake -Voluntary agreements with the industry -Reduction of salt content in artisanal bread -Public awareness on the need to lower salt intake RESULT: 44 companies and chambers of commerce have adhered to the agreement-8000 bakeries and NATIONAL LAW

Elimination of Trans Fat : BACKGROUND 2008: Declaration of Río de Janeiro: “Trans Fat Free Americas” 1.Replace trans fats in processed foods and use a concentration of not more than 2% of total fat in oils and margarines, and no more than 5% in processed foods; 2. Compulsory nutrition labeling 3. Develop educational programs for the population 4. Establish national working groups with the participation of industry, scientists and public health authorities PAHO: Trans Fats-Free Americas 2008: Ministry of Health called for inter-sectoral work to implement the recommendations of the Rio Declaration

Elimination of Trans Fat: STAKEHOLDERS, FACILITATORS AND BARRIERS STAKEHOLDERS BARRIERS FACILITATORS Leading role: - National Food Institute (INAL) - Ministry of Health Public sector: - Ministry of Agriculture, Livestock and Fishing. - National Institute of Industrial Technology (INTI) Industry Representatives : - Coordinator of Food Products Industries (COPAL) - Argentinian Association of Fats and Oils (ASAGA) Leading role: - National Food Institute (INAL) - Ministry of Health Public sector: - Ministry of Agriculture, Livestock and Fishing. - National Institute of Industrial Technology (INTI) Industry Representatives : - Coordinator of Food Products Industries (COPAL) - Argentinian Association of Fats and Oils (ASAGA) 70% of the companies are already in the process of retrofitting -International trend to work on these risk factors -Growing consumer demand for healthier food -Technical feasibility and existence of substitutes 70% of the companies are already in the process of retrofitting -International trend to work on these risk factors -Growing consumer demand for healthier food -Technical feasibility and existence of substitutes -Cost of alternatives -Unfair competition from small and medium enterprises -Uniform criteria for monitoring compliance -Contact small and medium enterprises -Cost of alternatives -Unfair competition from small and medium enterprises -Uniform criteria for monitoring compliance -Contact small and medium enterprises

Trans Fat elimination: ACTORS AND STRATEGIES Ministry of Health -Leaded the process and coordinated actions with other sectors -Called for meetings in 3 committees (Academic, Regulatory, Communication) -Leaded the process and coordinated actions with other sectors -Called for meetings in 3 committees (Academic, Regulatory, Communication) National Food Institute- INAL -Contributed with monitoring knowledge. -Presented the issue at local levels. - Participated in discussion with the companies -Elaboration of the manuals for Small and medium enterprise (SME) -Contributed with monitoring knowledge. -Presented the issue at local levels. - Participated in discussion with the companies -Elaboration of the manuals for Small and medium enterprise (SME) Ministry of Agriculture -Contributed with regulatory knowledge -Dissemination of information to SME -Participated in discussion with the companies -Elaboration of the manuals for Small and medium enterprise (SME) -Contributed with regulatory knowledge -Dissemination of information to SME -Participated in discussion with the companies -Elaboration of the manuals for Small and medium enterprise (SME) National Institute of Industrial Technology- INTI -Contributed with technical knowledge -Participated in discussion with the companies -Elaboration of the manuals for Small and medium enterprise (SME) -Contributed with technical knowledge -Participated in discussion with the companies -Elaboration of the manuals for Small and medium enterprise (SME) Coordinator of Food Products Industries - COPAL -Delegated the lead role in Argentinian Association of Fats and Oils (ASAGA) Argentinian Association of Fats and Oils - ASAGA -Contributed with technical knowledge -Represented the business sector in negotiating the measures. -Elaboration of the manuals for Small and medium enterprise (SME) -Contributed with technical knowledge -Represented the business sector in negotiating the measures. -Elaboration of the manuals for Small and medium enterprise (SME)

Elimination of Trans Fat RESULTS 1.December 2010: Agreement to eliminate trans fats and amendment of Article N ° 155 tris, Chapter III, the Argentine Food Code 2.Guide for small and medium enterprise: recommendations and strategies to replace trans fats 3.Consumer Information Campaigns 2014: End of adaptation period and starts the monitoring period The Ministry of Health and the National Food Institute are working on strengthening the food control system for the monitoring, and evaluation of measures.

Less Salt, More Life SODIUM REDUCCION: BACKGROUND 2010:Ministry of Health Called for inter-sectoral work to reduce sodium PAHO- Political Declaration for the Reduction of Cardiovascular Diseases in the Americas 1. Reducing salt intake in food 2. Goal for 2020: consumption goal of less than 5 grams a day per person 1.Public awareness on the need to lower salt intake. 2.Progressive reduction of salt in processed foods through agreements with the food industry. 3.Reduction of salt content in artisanal bread.

Sodium Reduccion: STAKEHOLDERS, FACILITATORS AND BARRIERS - INDUSTRY STAKEHOLDERS BARRIERS FACILITATORS Leading role: -Ministry of Agriculture, Livestock and Fishing. -Ministry of Health Public sector: -National Institute of Industrial Technology (INTI) -National Food Institute (INAL) Industry Representatives : -Coordinator for Food Product Industries (COPAL) -Chambers of Commerce Leading role: -Ministry of Agriculture, Livestock and Fishing. -Ministry of Health Public sector: -National Institute of Industrial Technology (INTI) -National Food Institute (INAL) Industry Representatives : -Coordinator for Food Product Industries (COPAL) -Chambers of Commerce -International trend to work on these risk factors -Growing consumer demand for healthier food -Avoid sudden implementation of measures that can be costly -International trend to work on these risk factors -Growing consumer demand for healthier food -Avoid sudden implementation of measures that can be costly -Discussion more difficult than Trans Fats: Taste, preserves food, no substitutes, component of many foods -Unfair competition from small and medium companies -Uniform criteria for monitoring compliance -Continuity of policy -Contact small and medium companies -Stricter measures -Discussion more difficult than Trans Fats: Taste, preserves food, no substitutes, component of many foods -Unfair competition from small and medium companies -Uniform criteria for monitoring compliance -Continuity of policy -Contact small and medium companies -Stricter measures

Sodium Reduccion: ACTORS AND STRATEGIES - INDUSTRY Ministry of Health -Coordinated the process and linked actions with other public agencies. -Disseminated information to consumers. -Coordinated the process and linked actions with other public agencies. -Disseminated information to consumers. Ministry of Agriculture -Contributed with regulatory knowledge -Dissemination of information to SME -Participated in discussion with the companies -Contributed with regulatory knowledge -Dissemination of information to SME -Participated in discussion with the companies National Food Institute - INAL -Contributed with monitoring knowledge. -Presented the issue at local levels. -Participated in discussion with the companies -Contributed with monitoring knowledge. -Presented the issue at local levels. -Participated in discussion with the companies National Institute of Industrial Technology - INTI -Contributed with technical knowledge. - Participated in discussion with the companies -Experience with bakers -Contributed with technical knowledge. - Participated in discussion with the companies -Experience with bakers Coordinator for Food Product Industries - COPAL - Represented the business sector in negotiating the measures. - Organized meetings with companies to agree on the terms and goals to be discussed with the Ministry of Health. - Collected and delivered information on sodium content in food. - Represented the business sector in negotiating the measures. - Organized meetings with companies to agree on the terms and goals to be discussed with the Ministry of Health. - Collected and delivered information on sodium content in food.

Sodium Reduccion: INDUSTRY RESULTS Progressive and voluntary reduction of sodium content for four food group (average 5% -15%): Selection criteria: 1.Large consumption 2.High content of sodium 3.Feasibility 44 COMPANIES AND CHAMBERS ADHERED FOR 487 PRODUCTS 1.Enforcement of agreements: INTER-SECTORAL NETWORK 2.Ministry of Health + INAL: working on strengthening food control system

Sodium Reduccion: ACTORS, FACILITATORS AND BARRIERS - BAKERIES STAKEHOLDERS BARRIERS FACILITATORS Leading Role: -National Institute of Industrial Technology (INTI) -FAIPA (Argentinean Federation of Baked Products Industries) -Ministry of Health Public sector: -Ministry of Health -National Institute of Industrial Technology(INTI) Industry representatives: -Argentinean Federation of Baked Products Industries (FAIPA) Leading Role: -National Institute of Industrial Technology (INTI) -FAIPA (Argentinean Federation of Baked Products Industries) -Ministry of Health Public sector: -Ministry of Health -National Institute of Industrial Technology(INTI) Industry representatives: -Argentinean Federation of Baked Products Industries (FAIPA) - Argentinean Federation of Baked Products Industries (FAIPA) commitment to health and good eating habits -Positive image among consumers, without requiring major investments or modifications of the production processes - Argentinean Federation of Baked Products Industries (FAIPA) commitment to health and good eating habits -Positive image among consumers, without requiring major investments or modifications of the production processes -Resistance of bakers to provide information on their products bakeries all over the country-more resources -Greater dissemination of the bakeries’ efforts. -Continuity of the policies -Resistance of bakers to provide information on their products bakeries all over the country-more resources -Greater dissemination of the bakeries’ efforts. -Continuity of the policies

Sodium Reduccion: ACTORS –STRATEGIES- BAKERIES Ministry of Health -Supported FAIPA and INTI National Institute of Industrial Technology – INTI -Researched on feasibility of reducing sodium in breads -Disseminated evidence -Provided training to the bakery sector. -Researched on feasibility of reducing sodium in breads -Disseminated evidence -Provided training to the bakery sector. Argentina Federation of Bakers - FAIPA -Wide commitment to the initiative -Suported the Ministry of Health to promote the initiative - Distributed and prepared materials to offer training materials to bakers. -Provided training to bakers. -Wide commitment to the initiative -Suported the Ministry of Health to promote the initiative - Distributed and prepared materials to offer training materials to bakers. -Provided training to bakers.

Sodium Reduccion: OUTCOMES - BAKERIES BAKERIES HAVE SIGNED THE COOPERATION AGREEMENT - ↓ 15-30% of sodium that is unnoticed by consumers -Province of La Pampa : epidemiological study

Sodium Reduccion: LESS SALT, MORE LIFE - RESULTS Food categories Average reduction % of fulfillment% of participation in the consumption # Bread25%80%20% Starchy8%85,5%60% Meat10%88%40% Dairy9,2%81,8%50% Soups6%96,4%75% Snacks11,4%100%60% Evaluation of voluntary agreements and goals * *For progress reports and labeling, pending laboratory analysis # Estimated from cameras and business reporting -Reduction of 0.92 grams sodium intake between 2011 and % drop table salt between 2011and 2012* -Reduction of 0.92 grams sodium intake between 2011 and % drop table salt between 2011and 2012* Source: Ministry of Health * Ministry of Agriculture, CCR Consulting

Sodium Reduccion: LESS SALT, MORE LIFE National Law for the Reduction Sodium Consumption Sets initial values of maximum sodium content for selected products Set future goals Health warnings on salt packages and restaurant menus Limits size of sodium envelopes to 0.5 grams Dissemination Campaigns Amend Argentine Food Code Research Sanctions

LEARNED LESSONS 1. Inter-sectoral dialogue and negotiation: Need to coordinate actions with other public sector actors to provide knowledge that are outside the capabilities of the Ministry of Health 2. Leading institution open to dialogue and negotiation 3. International trend that promotes work in promoting healthy diets 4. Increased demand for healthy food 5. The creation of an inter-sectoral working group LEARNED LESSONS -to improve- LEARNED LESSONS -to improve- 1. Limited resources 2. Small and medium enterprises are missing in the discussion 3. Monitoring and evaluation 4. The voluntary agreements do not have enforcement power. Long term: regulation 5. Lack of policy continuity 1. Limited resources 2. Small and medium enterprises are missing in the discussion 3. Monitoring and evaluation 4. The voluntary agreements do not have enforcement power. Long term: regulation 5. Lack of policy continuity

Conclusions: HIGHLIGHTS FROM THE EXPERIENCE -The feasibility and need to work in coordination between different sectors involved in food production -Essential that an institution is the promoter and coordinator of the measures -The feasibility and need to work in coordination between different sectors involved in food production -Essential that an institution is the promoter and coordinator of the measures FUTURE - New sources of financing - Strengthening monitoring and evaluation systems - Continue with the regulation of sodium. Law enforcement. - Disseminate information to the public about the risk factors and the actions taken to control them - New sources of financing - Strengthening monitoring and evaluation systems - Continue with the regulation of sodium. Law enforcement. - Disseminate information to the public about the risk factors and the actions taken to control them 2 DIFERENT STRATEGIES 1-TRANS FAT REGULACION: Amendment to the Argentine Food Code 2- SODIUM SELF-REGULATION: Voluntary agreements to reduce salt in processed foods and in breads prepared in artisanal bakeries

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