The Role of the Food Industry in Health Promotion

1. The Role of the Food Industry in Health Promotion George A. Mensah, MD, FACC, FACN, FCP (Hon) SAVP, Global R&D NutritionPepsiCo Presented at: Oxford Health Alliance Annual Summit 2011, Keble College, Oxford. Epidemic Chronic Disease - From Raising Awareness to Driving Change. April 14-15, 2011.

2. Conflict of Interest Disclosure and a Disclaimer • I am a full-time employee of PepsiCo. • These slides have not been reviewed or approved by PepsiCo. Thus, the contents should not be construed as necessarily representing the views of PepsiCo. • Any mention of food and beverage companies other than PepsiCo is for illustration only and does not imply the company’s endorsement or consent to be represented here.

3. “Performance with Purpose is at the foundation of every aspect of our business. Indeed, financial achievement can and must go hand-in-hand with sustainability. We integrate a commitment to human, environmental and talent sustainability into all of our operations. Doing so creates a blueprint for PepsiCo to develop, manufacture and sell our products in a sustainable way, gives us a competitive advantage in markets all over the world, which in turn drives long-term growth.” PERFORMANCE WITH PURPOSE PepsiCo’s responsibility is to continuously improve all aspects of the world in which we operate – products, environment, people – creating a better tomorrow for future generations.

4. The Times again lists PepsiCo U.K. & Ireland as a Top 50 Employer for Women, for the 5th time In addition to placing among the top 50, PepsiCo U.K. & Ireland was one of 3 finalists to be considered for an Opportunity Now Excellence in Practice Award for the category of Agile Organisation, recognizing companies for their approach to flexible working.

6. A Message from PepsiCo Global Health Policy What works? What can be scaled up? • Now is the time to provide leadership on what works and can be scaled up; and what may work and needs different partnerships and incentives to have impact. Congratulations to OxHA: • Successful CIH program • Earliest to lay out the economic case for multisectoral actions. • Stimulated debate about the role of urban design in building mobility and healthy eating into the structure of cities.

7. Whether or not the food industry has a role in health promotion is not the question • The main question is: what should that role be? • What concrete actions are being taken today in order to go from making pledges to driving change? • How can independent assessment of food industry compliance and health impact be ascertained? • What are the major challenges? What technological breakthroughs will accelerate change? • How do we best collaborate to drive change?

8. Multiple organizations and task forces have affirmed Industry’s role in promoting the public’s health • The World Health Organization • The World Heart Federation • The US National Academy of Sciences Institute of Medicine • International Obesity Task Force • The International Diabetes Federation • The Grand Challenges in NCD Prevention • The UK Government

9. Collective Food Pledges in the Public Health Responsibility Deal Core Commitment • We will encourage and enable people to adopt a healthier diet. Collective Pledges • Provide calorie information for food and non alcoholic drinks for our customers in out of home settings. • Commit to salt reduction targets for the end of 2012 agreed by the Responsibility Deal, which collectively will deliver a further 15% reduction on 2010 targets. • These targets will give a total salt reduction of nearly 1g per person per day compared to 2007 levels in food. • Remove, artificial trans fats from products by the end of 2011.

10. What pledges has PepsiCo UK & Ireland signed under the Public Health Responsibility Deal? Food Network Pledges • Out of home calorie labelling • Salt reduction • Artificial trans fats removal Health at Work Network Pledges • Chronic conditions guide • Occupational health standards • Health & wellness report • Healthier staff restaurants

11. Doing the right thing “You can depend on Americans to do the right thing, after they've tried everything else.”

12. What role should the food industry play?

13. Globalization and Health 2010; www.globalizationandhealth.com/content/6/1/10

14. Unhealthy diets Physical Inactivity Adverse social, economic, and environmental conditions Direct food industry actions Direct philanthropic actions Indirect food industry actions Food industry roles in health promotion to address the major chronic diseases Major Chronic Diseases 2 1 3

15. Food industry actions in support of healthful foods, snacks, and beverages - 1 • Improve the nutrient content and quality of foods and beverages through reformulation of existing products. • Control nutrients of public health concern such as added sugar, sodium, trans fats, and also total calories per serving. • Introduce new products that enhance positive nutrition by the addition of increased amounts of whole grains, fruits and vegetables, nuts and seeds, and low-fat dairy in accordance with dietary guidelines. • Expand options for reducing portion size through the use of smaller package sizes, and development of products that address satiety and appetite control. • Invest in R&D to enable technological breakthroughs to accelerate product reformulation.

16. Food industry actions in support of healthful foods, snacks, and beverages - 2 • Invest in research advances in agronomy, agricultural policy, diverse sources of calories in the community, and behavioral economics. • Adopt established labeling policies, and adopt established advertising and marketing policies, especially as they apply to children. • Support nutrition education and physical activity programs with an emphasis on energy balance. • Invest in workplace wellness initiatives.

17. PepsiCo’s 2010 Annual Report: Performance with Purpose: The Promise of PepsiCo www.pepsico.com/Download/PepsiCo_Annual_Report_2010_Full_Annual_Report.pdf

18. Direct corporate action involves increasing some nutrients and food groups while limiting others Nutrients to Encourage Food Groups to Increase Nutrients to Limit Omega-3 fatty acids Sugar Non-starch polysaccharides Salt Flax seed oils Whole grains Saturated Fat

19. PepsiCo has adopted a science-based framework for food industry innovation • Fruits/Vegetables Whole Grains • Cardiovascular risk reduction • Cardiovascular risk reduction Low-fat Dairy • Overall health promotion • Sweeteners • Sodium • Obesity prevention • Blood pressure control • Saturated Fats • Total Calories • Atherosclerosis prevention • Obesity prevention Trans Fats • Atherosclerosis prevention

20. PepsiCo human sustainability goals regarding key food and beverage brands • Increase the amount of whole grains, fruits, vegetables, nuts, seeds, and low-fat dairy. • Reduce the average amount of sodium per serving by 25% by 2015. • Reduce the average amount of saturated fat per serving by 15% by 2020. • Reduce the average amount of added sugar per serving … by 25% by 2020.

21. Our Global Goals and Commitments in the marketplace are also important • Display calorie count and key nutrients on packaging by 2012. • Advertise to children less than 12 years of age only products that meet our global science-based standards. • Eliminate the direct sale of full-sugar soft drinks in primary and secondary schools around the globe by 2012. • Increase the range of foods and beverages that offer solutions for managing calories, like portion sizes.

22. Our Global Goals and Commitments in the community are also important • Assure affordable, nutritionally-relevant products for underserved and lower-income communities. • Invest in initiatives to promote healthier communities, including enhancing diet and physical activity programs. • Integrate our policies and actions on human health, agriculture and the environment.

23. 5 actions over of 5 years Food reformulation Consumer information Responsible marketing Promotion of healthy lifestyles Public-private partnerships Commitments signed by the Chief Executive Officers of: Ferrero General Mills Grupo Bimbo Kellogg’s Kraft Foods Mars Nestlé PepsiCo The Coca-Cola Company Commitments Made by the International Food and Beverage Alliance (IFBA), May 2008 IFBA, November 2009. https://www.ifballiance.org

24. These 10 Companies Alone Contribute 83% of Global Food, Beverage and Restaurant Advertising Spend Courtesy of John Fletcher, PepsiCo International

25. Transforming the portfolio in UK & Ireland is not a trivial pursuit PepsiCo UK & Ireland – Health Report 2010 The Grocer l 31 July 2010 l www.thegrocer.co.uk

26. Goals and commitments made by PepsiCo UK & Ireland - 1 ● Invest 70% of R&D budget to deliver products defined as healthier** from 2012. ● Deliver 1.8bn servings of fruit & veg and 1.7bn servings of whole grain per annum by 2012. ● At least 50% of savoury snacks to be baked or include positive nutrition* by 2015. ● All crisps and snacks to meet or surpass existing FSA salt reduction targets by 2012. ● A 4% cut in sugar level of regular Pepsi by 2012 subject to consumer trials; 65% of carbonated soft drinks can and bottle sales no-sugar by 2015.

27. Goals and commitments made by PepsiCo UK & Ireland - 2 ● Introduce single-serve calorie cap of 160 calories across single serve savoury snacks without “positive nutrition benefits”. ● Trial marketing campaigns to transition consumers, who have high per-capita consumption of savoury snacks and full-sugar soft drinks, to healthier alternatives from 2010. ● Increase availability of Walkers Baked and Pepsi Max by 25% by 2012 for consumers on the go.

28. Goals and commitments made by PepsiCo UK & Ireland - 3 ● All Pepsi ads to back growth of no-sugar or natural from 2010. ● 60% of total sales volume to be defined as healthier* by 2015. ● Work with government and other stakeholders to deliver pledges on portion sizes and availability of healthier products. ● Quaker and Tropicana to donate to breakfast clubs in deprived areas. ● Support Change4Life through promoting healthy breakfasts and other activities.

29. What concrete actions are being taken today?

30. Increase the range of foods & beverages that offer solutions for managing calories, like portion sizes. • In 2010, we continued to launch new products with zero- and low-calorie sweeteners and reformulated existing products with fewer calories. • Naked Juice, for example, introduced a 100% juice smoothie that has 35 percent fewer calories than its predecessor. • Tropicana added new varieties to its Trop 50 line, which offers 50 percent less sugar and fewer calories with no artificial sweeteners. • In Mexico, a baking technique is used to produce a version of Sabritas potato chips with 20% less calories.

31. Overall reduction of added sugars First major food company to introduce zero-calorie, allnatural sweetener derivedfrom the stevia plant Orange juice available with50% less sugar and calories Instant oatmeal available with50% less sugar than regularinstant oatmeal

32. Selected PepsiCo examples of all-natural, zero-calorie and reduced or low sugar beverages • In the US, we introduced an all-natural, zero-calorie sweetener in our SoBe Lifewater brand and launched eight different flavors to provide consumers with a wide range of naturally sweetened options. • In Turkey, a leading beverage, Fruko Gazoz, was reformulated with a sweetener blend that reduces sugar content by 32 percent. • In Brazil, we recently acquired Amacoco, to broaden the distribution and sales of our low-sugar coconut water product line.

33. Eliminate direct sale of full-sugar soft drinks to primary & secondary schools globally by 2012. • In 2009, we discontinued sales of full sugar soft drinksto K-12 schools in the U.S. and replaced them with smaller portioned and lower-calorie options, as part of a voluntary commitment with the Alliance for a Healthier Generation. • We do not sell full-sugar soft drinks directly to primary and, in some cases, secondary schools in most of Europe, Canada and the majority of countries in the Arabian Peninsula. • In this past year we committed to extending our US school beverage policy globally by 2012.

34. Percent Change in Total Volume of Beverage Shipments to All Schools, 2004 to 2009-2010, USA ABA. Alliance School Beverage Guidelines Final Progress Report, 2010; www.ameribev.org

35. Under the EU Pledge, Accenture reports a decline in advertising since 2005 for non-compliant foods 93% for programs with an audience composed of a majority of children <12, and a 56% decline overall, i.e. in all programs on all channels at all times Blue = Noncompliant products Red = Noncompliant products in spots with a reported profile >50%

36. Overall fats reduction efforts In Europe and UK, we introduced baked potato crisps with 70% less fat than regular crisps Use of Sunseed (Europe) and NuSun (US) By reformulating our British crisp brand with Sunseed, we removed 40,000 tons of saturated fat from the British diet Frito-Lay: first major food company to remove trans fats from entire snack chip portfolio (2003) Reduced trans-fatty acid content in Mexican cookie brand from 15%-30% to virtually zero Removed 10,000 tons/yr. of trans-fatty acid from food supply

37. PepsiCo UK & Ireland – Health Report 2010

39. PepsiCo UK portfolio (2008) — Retail sales by brand Total PUK sales: £1.5 billion + PepsiCo UK & Ireland – Health Report 2010

40. UK Sales 2008 – Regular Pepsi/7UP vs. No sugarbeverages, overall % gross revenue Source: Nielsen ScanTrack, Full Year 2008, Total Market UK.

41. Examples of direct philanthropic actions for the prevention & control of obesity, diabetes, HTN • Unrestricted research grants to support community interventions in health. • PepsiCo Foundation philanthropic initiatives promote healthier communities through enhancing diet and physical activity programs. • PepsiCo Foundation support to key academic and community organizations working to address nutrition challenges.

42. Examples of direct corporate actions for the prevention & control of chronic diseases • Support for nutrition & health science meetings. • In-house, collaborative and sponsored research. • To implement improved nutrition in a marketplace requires more than just ‘nutrition research’ • Often fundamental changes are needed and a deeper understanding from consumer insights research necessary. • Support for physical activity programs.

43. Industry supports physical activity programs, sports events, and celebrities through endorsements

44. Independent assessment of industry compliance is necessary

45. Trans fat (TFA) content of major US supermarket and restaurant foods before and after food reformulation A Supermarket Products Restaurant Products Mozaffarian & Jacobson. NEJM 2010; 362:2037-2039

46. Summary and Conclusions - 1 • Industry plays important business and philanthropic roles in health promotion. • Product reformulation and changes in packaging and advertising practices are key business strategies. • Progress is sometimes slow and uneven, but there is a huge commitment in the major global food producers. • Breakthroughs in agriculture, behavior economics, food science, and processing technology are also needed. • Strong partnerships with industry are needed.

47. Summary and Conclusions - 2 • The entire food and beverage industry needs to be involved in health promotion. • The International Food & Beverage Alliance companies are increasing commitments to public health. • However, the impact and magnitude of the contribution to the total market share of foods and beverages consumed remain incompletely understood. • Independent monitoring and evaluation of industry compliance with commitments are necessary.