November 2013

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

2. Chronic non-communicable diseases (CNCD) and prevalence of risk factors in Argentina. 80%Of deaths can be attributed to CNCD* 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 Source: National Survey of Risk Factors 2005 and 2009 *Source: WHO- Source: Ministry of Health

3. Salt Consumption in Argentina 2005-2009. ¿Do you always/almost always addsalt to the food after it was cooked? 12 Grams per day is the consumption of sodium per person in Argentina 5Grams per day is the consumption of sodium recommended (WHO) 4Grams per day comes from bread 60%of salt ingested comes from processed foods Source: National Survey of Risk Factors 2005 and 2009 Source: Ministry of Helath

4. 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.

5. Elimination of Trans Fat and Reduction of sodium: Background. Trans Fat (TF) 1. Its consumption ↑the risk of coronary disease and diabetes. 2. There aretechnically and economically feasible procedures to replace them 3. ↓ 2%in consumption of TF would avoid between 30.000 and 130.000 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.

6. Elimination of Trans Fat and Reduction of sodiumIMPLEMENTED 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 -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 -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

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

8. Elimination of Trans Fat :BACKGROUND 2007-PAHO: Trans Fats-Free Americas 2008: Declaration of Río de Janeiro: “Trans Fat Free Americas” • 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. 2008: Ministry of Health called for inter-sectoral work to implement the recommendations of the Rio Declaration

9. Elimination of Trans Fat:STAKEHOLDERS, FACILITATORS AND BARRIERS FACILITATORS BARRIERS STAKEHOLDERS 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 -Cost of alternatives -Unfair competition from small and medium enterprises -Uniform criteria for monitoring compliance -Contact small and medium enterprises

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

11. Elimination of Trans FatRESULTS • 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.

12. Less Salt, More LifeSODIUM REDUCCION: BACKGROUND 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 2010:Ministry of Health Called for inter-sectoral work to reduce sodium • Public awareness on the need to lower salt intake. • Progressive reduction of salt in processed foods through agreements with the food industry. • Reduction of salt content in artisanal bread.

13. Sodium Reduccion:STAKEHOLDERS, FACILITATORS AND BARRIERS - INDUSTRY FACILITATORS BARRIERS STAKEHOLDERS 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 -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

14. Sodium Reduccion:ACTORS AND STRATEGIES - INDUSTRY Ministry of Health National Institute of Industrial Technology - INTI -Coordinated the process and linked actions with other public agencies. -Disseminated information to consumers. -Contributed with technical knowledge. - Participated in discussion with the companies -Experience with bakers Ministry of Agriculture Coordinator for Food Product Industries - COPAL -Contributed with regulatory knowledge -Dissemination of information to SME -Participated in discussion with the companies - 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. National Food Institute- INAL • -Contributed with monitoring knowledge. • -Presented the issue at local levels. • -Participated in discussion with the companies

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

16. Sodium Reduccion:ACTORS, FACILITATORS AND BARRIERS - BAKERIES FACILITATORS BARRIERS STAKEHOLDERS 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 • -Resistance of bakers to provide information on their products • -30.000 bakeries all over the country-more resources • -Greater dissemination of the bakeries’ efforts. • -Continuity of the policies

17. 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. 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.

18. Sodium Reduccion: OUTCOMES - BAKERIES • 8.000 BAKERIES HAVE SIGNED THE COOPERATION AGREEMENT • ↓ 15-30% of sodium that is unnoticed by consumers • Province of La Pampa : epidemiological study

19. Sodium Reduccion: LESS SALT, MORE LIFE - RESULTS Evaluation of voluntary agreements and goals2011-2013* *For progress reports and labeling, pending laboratory analysis # Estimated from cameras and business reporting Source: Ministry of Health * Ministry of Agriculture, CCR Consulting -Reduction of 0.92 grams sodium intake between 2011 and 2013 - 6% drop table salt between 2011and 2012*

20. 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

21. LEARNED LESSONS LEARNED LESSONS -to improve- 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 negotiation3. International trend that promotes work in promoting healthy diets4. Increased demand for healthy food 5. The creation of an inter-sectoral working group • 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

22. Conclusions: 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 HIGHLIGHTS FROM THE EXPERIENCE FUTURE -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 - 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

23. Thank You very much!