SA not yet ready for health claims on food labels

 

According to Todd, challenges such as literacy levels, and the legibility of labels, stand in the way of health-related food labels being used adequately.

“The socio-economic circumstances prevalent in South Africa drive large volumes of food sales in informal markets where labels are often not present,” she adds. “Unresolved questions about the substantiation and enforcement of health claims, combined with no solution being apparent for reaching consumers in the informal market, would limit the benefits that could be associated with the implementation of health claims at this point in time.”

Food labels were first used to facilitate trade between countries and ensure overall food safety, but have increasingly been used to inform and to educate.

Theoretically, more detailed nutritional information on food labels should enable more consumers to make informed choices, and in the long run even be able to play a role in curbing the development of lifestyle related non-communicable diseases.

That’s easier said than done, Todd notes, because consumers often struggle to read labels adequately, and to interpret the nutritional information it contains.

According to Regulations Relating to the Labelling and Advertising of Foodstuffs (No R146) of 2010, all food labels in South Africa must include an ingredient list. Those that make claims about a foodstuff’s nutrient content must also include a nutrition information panel.

“Consumers do get some protection with nutrient content claims having strict specifications for a claim that the product is ‘a source of’ or ‘high in’ a particular nutrient. However, unless there is a nutrient content claim, consumers have only an ingredient list from which to deduce the dietary characteristics of the food,”

She says current legislation does not permit specific health claims on labels. This might change, if draft amendments, already on the table since 2014, is ever accepted. These include guidelines on the use of selected health claims, such as ones that particular foodstuffs could help improve blood glucose control or cause high cholesterol.

“After seven years in draft format, it remains unclear if this legislation will be promulgated,” Todd notes as an aside.

She says that if the 2014 draft legislation is ever agreed on, the issue of language would still need to be considered. As it stands, the proposed health claims in draft legislation (R429) only appear in English.

“Most labels on South African foodstuffs are printed in English, despite only 12% of the South African population in 2016 citing English as their home language,” she says.

“No African languages currently appear on our food labels. The available space for nutritional information in additional languages is difficult on small packages. Omission is however not excusable in cases where nutritional information is available in foreign languages such as French and Portuguese, on foodstuffs that are also being packaged for export to other African countries, for instance.

Todd believes the inclusion of foreign languages comes at the expense of local consumers who cannot speak English, or do not understand it very well.

Therefore, within the South African context, she thinks it wise to limit foreign languages on packaging, unless at least one African language is present.

“As a starting point, label information could be available in multiple African languages on company websites. Whilst this technological approach will not be accessible to all, this will at least empower consumers with the means and interest to engage the information more so than in the past,” she notes.

According to recent research, approximately 56.3% of the South African population used the internet in 2020.

Another issue is the low socio-economic status of so many South Africans. It means that many simply cannot be selective about their food choices. They will therefore be unlikely to refer to food labels to inform their food choice, irrespective of the additional health claims that might one day be printed on them.

“Furthermore, up to 40% of all food in South Africa is sold in the informal market, where products are often devoid of food labels. That’s a sizeable and increasing portion of the market,” says Todd.

With adult literacy rates in the decline, according to World Bank statistics last year, she sees value in including visual labels which use colour and shapes rather than numerals to help consumers make adequate deductions.

“Pictorial labels exist in various formats across the globe, for example, the Health Star rating in Australia or the stop sign warning labels in Chile, but an ideal format for South Africa must still be determined,” Todd notes. “It would ideally be accompanied by a nation-wide education campaign.”

Certain manufacturers incorporate the Guideline Daily Amount (GDA) label on their food product, although it is not mandatory. A recent review of front of pack label research however indicated that the tool is largely useless.

“Considering the challenges mentioned relating to literacy, motivation and health knowledge, it is uncertain how effective this GDA format is and whether it is the correct format for South Africa. In terms of the use of health claims on packaging, one therefore has to carefully consider what the ideal design thereof should be, and how such claims can be made more accessible to consumers.”

Todd’s study also highlighted the issue of font size used on food labels.

“It is often cited as a challenge to consumer’s ability to adequately read and understand a label. This indicates that food labelling is seen as a compliance exercise, and nothing more. Food labelling regulations specify minimum font sizes, but it leaves ‘legibility’ open to interpretation, and participants in my research indicated abuse in both instances.”

She says font size is especially challenging in developing countries where the level of visual impairment and lack of access to eye care exacerbates the issue.

“Policy-makers can enhance legibility through mandating black text on a white background (as is the case in the United States), or require that the font size of regulatory information be relative to package size.”

She believes research is needed into the most effective format for food labels used in South Africa. This would include issues about the use of health warnings on foodstuffs, compared to ones that are unlabelled.

“Unlabelled food constitutes a large portion of food sold,” Todd notes.

“It is necessary to remain realistic about the role that food label-based health communication interventions will play in reducing the burden of non-communicable diseases,” she adds. “With some refinement, food labels can potentially prompt healthier choices, for some consumers, some of the time. However, any food labelling intervention in South Africa will still leave a large and increasing portion of the market behind.

“The success of any intervention will be reliant on honesty and compliance by the nation’s food manufacturers.

“Based on challenges highlighted in this research, South Africa is not yet geared to implement health claims since gaps exist in terms of both enforcement and evaluation of claims. Changes to food labelling may appear to be a quick win to address the growing NCD burden; however, it fails as a suitable intervention if it creates value for some stakeholders at the expense of others.”

Todd believes it may be a good time for the food industry to look at their products and question whether they are really doing the best job they can “to make the healthy choice the easy choice” – irrespective of whether the consumer can read the label or not. Simultaneously, policy makers need to step up and act against those who do not follow the law.

“Leadership and courage are required to create a safe and mature space where stakeholders can engage constructively to tackle the NCD burden.”

Reference: Todd, M., Guetterman, T., Sigge, G., Joubert, E. (2021). Multi-stakeholder perspectives on food labeling and health claims: Qualitative insights from South Africa. Appetite