What’s on the Menu:
Nutrition in Public Health
Striking A Balance – Weigh-In with Knowledge, Research,
Education and Practice Symposium
30 September 2013
Speaking notes of
Bill Jeffery, LLB, National Coordinator
Diet-related disease causes real, avoidable
deaths and economic loses, both on a grand scale.
For example, in Canada…
• An average of nearly 5 years of healthy life expectancy is lost due to six diet-related risk
factors. (See: World Health Organization, The World Health Report 2002, (Geneva: WHO, 2002). Esp. see Table 4 in the annex which shows that loss of healthy
life expectancy due to all risk factors is 9.4 disability-adjusted-life-years averaged for Canadian men and women at http://www.who.int/whr/2002/en/whr2002_annex4.pdf)
and Table 10 which shows that, in developed countries, 50% of all-risk-attributable Disability-Adjusted Life Years (DALYs) were lost due to blood
pressure, cholesterol, overweight, low fruit and vegetable intake, and certain rare types of childhood and maternal undernutrition at
http://www.who.int/whr/2002/en/whr2002_annex9_10.pdf). So, 50% of 9.4 years is 4.7 years.)
• And estimated 48,000 premature deaths annually are caused by diet-related disease due
mainly to cardiovascular disease, diabetes, and certain cancers caused by excess sodium
intake, risky blood cholesterol and glucose levels, inadequate fruit and vegetable
intake, and excess abdominal body fat. World Health Organization. Global Health Risks: Mortality and burden of disease attributable to selected
major risks. 2009. W.H.O. Geneva. See, esp. p. 17. Available at: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf Statistics Canada.
Mortality, Summary List of Causes. 2008. Ottawa. Catalogue no. 84F0209X which indicates the total number of deaths in 2008 was 238,617, 20% of which is: 47,723. Available at:
http://www.statcan.gc.ca/pub/84f0209x/84f0209x2008000-eng.pdf See, for example, the extrapolation from published figures in endnote 11 at:
http://cspinet.org/canada/pdf/Eng_CSPI_Finance.pdf which, through crude, is also consistent on a per capita basis with the 365,000 annual US deaths attributed to poor
diet and physical inactivity. (cf. Mokdad AH, et al, “Actual Causes of Death in the United States, 2000” 291(10) Journal of the American Medical Association 1238-
1245, and 293(3) pp. 293-4, 298. See also, the Drummond Commission Report (2012), recommendation #5-85 at
• A total of $5-30 billion per year is lost from the Canadian economy as a whole (avoidable
health care costs and lost productivity) Public Health Agency of Canada. Obesity in Canada. 2010. Ottawa at 28-29. Available at:
http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/oic-oac/assets/pdf/oic-oac-eng.pdf; Anis AH, Zhang W, et al. Obesity and overweight in Canada: An updated cost-of-illness study. Obesity
Reviews. 2009;11(1):31-40;Behan DF, Cox SH, et al. Obesity and its Relation to Mortality and Morbidity Cost. December 2010. Committee on Life Insurance Research. Society of Actuaries.
University of Manitoba. Winnipeg.
Overarching Disease Reduction Goal:
• WHA: NCD deaths 25% by 2025 or 48,000 fewer deaths annually
– approx. 190,000 Canadian deaths annually due to NCDs;
– approx. 100,000 due to alcohol+tobacco+diet;
– Approx. 48,000 deaths due to poor nutrition.
• Probably requires taking all the measures CSPI advocates (plus stronger action on
tobacco, alcohol control), e.g.
– halve sodium levels in food supply,
– eliminate synthetic trans fats,
– ban commercial ads targeting children,
– improve nutrition labelling on the front of food packages,
– reform food taxes to promote, not discourage healthy eating,
– make Canada’s Food Guide more persuasive and more consistent with science,
– Mandate sensible nutrition standards for school foods and subsidize school meals to a level
more in keeping with other OECD countries
– spur other changes in procurement;
– mandate calories, high-sodium notices on restaurant menus
Heart and Stroke Foundation’s
Make the Last 10 Years Count
How we advocate
public health nutrition law reforms
• Publish: Nutrition Action, policy reports, journal articles, op-eds, book
chapters, briefing notes, technical briefs, news releases, etc.
• Testify: before legislative committees, esp. House of Commons Standing Cttee. on
Health and the Codex Food Labelling Cttee (based on World Health Org., U.S. Institute
of Medicine, United Nations, OECD, Supreme Court, etc., etc.)
• Media: interviews for print, and broadcast media
• Participate: in formal advisory committees, e.g., the Trans Fat Task Force, Sodium
• Meet elected officials and government bureaucrats: esp. at Health Canada, Canada
Food Inspection Agency, and increasingly in provincial and municipal health authorities
• Mobilize supporters: meet, call, and write NGOs, experts and grassroots supporters to:
– seek their advice (and share ours),
– mobilize their support (and offer ours), and
– (occasionally) enlist their financial support for our conferences
• Convene: conferences of experts, policy-makers and journalists
E.g. Campaign #1
Conflicts of Interest Coalition/Network
159 groups and networks representing 2,000+ NGOs
E.g. Campaign #2:
70 community leaders (w/ 8 millions Canadian members)
Bill C-460, Sodium Reduction Strategy for Canada Act
failed 147-122 vote May 8, 2013; the end of the beginning…incl.
a role for provinces
Sodium Reduction Bill
60+ NGO and expert supporters (w/ links to at least 2/3 of households)
E.g. Campaign #3
Int’l standard-setting may lead the way
E.g., Campaign #4
Trans Fat Regulations could…
Prevent 1,000+ deaths per year
Average of $250 M-$450 M
E.g. Campaign #5
School Food Nutrition Standards
& Subsidies (4¢$1.30 but universal?)
Featured Campaign “A”:
Federal Bill, C-430, to restrict advertising to children
(as Quebec legislature has done since 1980)
• Call for supporters
• Debate and vote as early as
the conditions are right
• How will Liberals vote?
• How will 5 Quebec
Conservative MPs vote?
Undoing the harm of advertising to children:
Skim worst junk food ads?
Policy Context in Quebec
•Consumer Protection Act, R.S.Q., c. P-40.1
o Section 248. Subject to what is provided in the
regulations, no person may make use of
commercial advertising directed at persons
under thirteen years of age.
o Section 249. To determine whether or not an
advertisement is directed at persons under
thirteen years of age, account must be taken of
the context of its presentation, and in particular
(a) the nature and intended purpose of the
(b) the manner of presenting such
(c) the time and place it is shown.
•Where children consist of 15% of the audience
• Sections 87–91 of the regulations (permitting
magazines to carry certain advertisements provided
they satisfy sixteen criteria designed to limit the
exploitation of vulnerable children).
Bigger impact on Francophone kids?
• 4-fold as many TV food
ads seen by minority
English children in
Quebec compared to
• Unclear from study what
share of large number of
ads seen in Quebec were
examples of border
leaking, law violations, or
Dhar T and Baylis K, American Journal of Marketing. 2011
• Decrease in purchase
propensity by 13% per
week reduced fast-food
consumption by US $88
million per year
Data on health impact of the ban is scarce and speculative, but see:
Sarah Carr, Overweight in Canadian Children, Mapping the Geographic Variation (M.Sc. Thesis), London School of Hygiene and
Tropical Medicine, 2004. Based on Data made available to the author from Refreshments Canada and Statistics Canada
(Catalogue 91-002, 91-210).
Figure 25: Soft Drink Consumption (1978-2000)
1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
More advertising overall in
Canada outside Quebec?
-28% = food advertisements
-4.9 food advertisements/hr
-High in fat and alcohol, low fibre
-15% = food advertisements
-5.1 food advertisements /hr
- High in fat, sodium, low fibre
- Decrease in fruit and vegetables,
juices, other beverages, meats,
spreads and chewing gum
- -Increases in milk, milk products,
Adams et al.(2009). Changes in food advertisements during prime-time television from 1991 to 2006 in the U.K. and Canada. British
Journal of Nutrition. 102, 584-593.
Proportion of food ads for High Fat Sugar and Salt
down from 4/5 to 3/5
European Congress on Obesity Research,
Liverpool, May 2013
• The overall percentage of UK child-directed food
advertisements decreased slightly, from 13% in 2008 to
11.7% in 2010, and there was less advertising of both
core foods (25.5% to 19.1% of food advertising) and
noncore foods (64.2% to 57.6%).
• Increases took place, however, in the proportion of ads
promoting confectionery (8.8% to 10.7%), full-fat dairy
products (3.9% to 8.7%), and high-fiber/low-sugar
breakfast cereals (7% to 8%).
More disappointing news from the UK
(WHO Regional Office for Europe. Marketing of foods high in fat, salt and sugar to children: update 2012–2013. 2013
at 22 and 24. Available at: http://www.euro.who.int/__data/assets/pdf_file/0019/191125/e96859.pdf )
• spending on HFSS ads
declined 2008-2012 in
the UK, volume of
rose during that period.
Jurisprudence, scientific evidence & expert opinion
about the vulnerability of children to
Irwin Toy company challenge, 1980-1989
(Attorney General of Québec v. Irwin Toy, Ltd.,  1 S.C.R. 927.)
Official court report: http://scc.lexum.org/decisia-scc-csc/scc-csc/scc-csc/en/443/1/document.do
Searchable court report: http://www.canlii.org/en/ca/scc/doc/1989/1989canlii87/1989canlii87.html
• “...advertising directed at young children is per se manipulative.
Such advertising aims to promote products by convincing those
who will always believe.”
• Supreme Court of Canada accepted the following explanation of the
objective of the legislation: “The concern is for the protection of a
group which is particularly vulnerable to the techniques of
seduction and manipulation abundant in advertising.” (p. 987).
• Ban is a permissible limit on commercial freedom of expression
under the Charter of Rights and Freedoms (Irwin Toy, 1989, p.
• The court relied heavily on the 1981 U.S. Federal Trade
Commission’s report entitled Final Staff Report and
Recommendation, In the Matter of Children’s Advertising. The
report concluded that:
– the specific cognitive abilities of young children lead to their inability to fully understand child-
oriented television advertising, even if they grasp some aspects of it. They place indiscriminate trust
in the selling message. They do not correctly perceive persuasive bias in advertising, and their life
experience is insufficient to help them counter-argue.… As a result, children are not able to evaluate
adequately child-oriented advertising. (Irwin Toy, 1989, p. 988).
Reaffirmed in 2004 in Brian Wilcox, Task Force Chair, Report of the APA Task Force
on Advertising and Children (Washington, DC: American Psychological
Association, February 20, 2004)
Jeffery B. The Supreme Court of Canada's Appraisal of the 1980 Ban of Advertising to Children in Quebec:
Implications for "Misleading" Advertising Elsewhere.” 39 Loyola of Los Angeles Law Review 237-276 (2006).
General Common Law
(Attorney General of Québec v. Irwin Toy, 1989, p. 990).
The Supreme Court of Canada, in Irwin Toy,
summarized the unique status of children in
the common law as follows:
– “viz. to protect a group that is most vulnerable to
commercial manipulation … *is+ reflected in
general contract doctrine.… Children are not as
equipped as adults to evaluate the persuasive
force of advertising and advertisements directed
at children would take advantage of this”
G. Hastings, Et Al., Review Of Research on the Effects of Food Promotion to Children, prepared for the UK Food
Standards Authority, (London: UK FSA, and Glasgow, Scotland: Centre for Social Marketing, University of
Strathclyde, 2003), 19, 87-8, 138 at http://www.food.gov.uk/multimedia/pdfs/foodpromotiontochildren1.pdf
• Seminal systematic review of English literature on
advertising directed at children concluded:
– foods marketed to children tend to be of
very low nutritional value;
– that there is reasonably strong evidence of
that food promotion affects both brand
and category preferences, and evidence of
a strong effect of food promotion on
children’s purchasing and purchase-related
– at around age eight, children are just
“beginning to respond to advertising in a
more sophisticated way” and that
children’s ability to retrieve and process
information is still developing between
the ages of eight and twelve (pp. 35–36).
And another systematic analysis of 123 eligible studies:
Inst. of Med. of the Nat’l Acads. of Sci., Food Marketing to Children and Youth: Threat or Opportunity
(J. Michael MgGinnis et al. eds., 2006) [in press] . See the exec. summ. at
• Children begin to develop
cognitive skills at age 8 to ascertain
commercial intent of advertising --
passively until age 11 (or older?);
• little research on children aged
• Recommend federal legislation for
TV and cable ads if voluntary efforts
to “shift away from high-
calorie, low-nutrient foods” are
American Psychological Association
2004 Report of the APA Task Force on Advertising and Children,
(Brian Wilcox, Task Force Chair). Washington, DC: APA. On the World Wide Web at
Children, because they are still maturing, have very poor
cognitive defences against commercial advertisements
(APA, 2004, pp. 6–7).
“the ability to recognize persuasive intent does not develop
for most children before 8 years of age.… Even at that age …
such capability tends to emerge in only rudimentary form”
(APA, 2004, p. 9).
“Further investigation is needed to establish the upper
age boundary of children who are uniquely vulnerable to
televised commercial persuasion as a function of
normative developmental limitations on their
information-processing capabilities...[T]he evidence points
directly to one fundamental concern: that advertising
targeting children below the ages of 7–8 years is inherently
unfair because it capitalizes on younger children's inability
to attribute persuasive intent to advertising. As a result of
this limitation, children below this age comprehend the
information contained in television commercials
uncritically, accepting most advertising claims and appeals
as truthful, accurate, and unbiased.
Key, Relevant Canadian Federal Laws
• subsection 9(1) of the
Act, itself, requires
citizens to be at least 18
years old to petition for
an investigation of
• s. 16 creates a
children under the age
of fourteen are not
• See also the Supreme
Court of Canada ruling
in Kendall v. The Queen
Justice for Children and Youth
survey of Ontario and federal laws
• Of nearly 70 age-delimited legal milestones
(rights and responsibilities), only 3 vest in
children under age 12:
– the statutory right then duty to attend school
from age 4 (or 5) then 6, respectively,
– the authority to withhold consent to be adopted
at age 7
Age of Majority and Accountability Act,
(Ontario) R.S.O. 1990, c. A.7
• the age of majority is 18 (down from 21,
generally, in common law)
• five of the other nine provinces set it at 19
• United Nations International Convention on
the Rights of the Child = 18
• minors may enter into binding (enforceable)
contracts for the “necessities of life”
Relevant provincial limits on misleading, deceptive
advertising analogous to the federal Competition Act
Consumer Protection Act, S.O. 2002, C. 30
False, misleading or deceptive representation
14. (1) It is an unfair practice for a person to make a false, misleading or deceptive representation.
15. (1) It is an unfair practice to make an unconscionable representation. 2002, c. 30, Sched. A, s. 15 (1).
(2) Without limiting the generality of what may be taken into account in determining whether a representation is unconscionable, there may be taken into
account that the person making the representation or the person's employer or principal knows or ought to know,
(a) that the consumer is not reasonably able to protect his or her interests because of disability, ignorance, illiteracy, inability to understand the language of
an agreement or similar factors;…
Unfair practices prohibited
17. (1) No person shall engage in an unfair practice. 2002, c. 30, Sched. A, s. 17 (1).
(12) Each person who engaged in an unfair practice is liable jointly and severally with the person who entered into the agreement with the consumer for
any amount to which the consumer is entitled under this section. 2002, c. 30, Sched. A, s. 18 (12).
Ministry receives complaints and makes inquiries
105. The Ministry may,
(a) receive complaints concerning conduct that may be in contravention of this Act, of other legislation for the protection of consumers or of any other
prescribed Act, whether the conduct constitutes an offence or not; and
(b) make inquiries, gather information and attempt to mediate or resolve complaints, as appropriate, concerning any matter that comes to its attention
that may be in contravention of this Act, of other legislation for the protection of consumers or of any other prescribed Act, whether the matter
constitutes an offence or not. 2002, c. 30, Sched. A, s. 105.
False, misleading or deceptive representation
109. (1) If the Director believes on reasonable grounds that any person is making a false, misleading or deceptive representation in respect of any
consumer transaction in an advertisement, circular, pamphlet or material published by any means, the Director may,
(a) order the person to cease making the representation; and
(b) order the person to retract the representation or publish a correction of equal prominence to the original publication. 2002, c. 30, Sched. A,
s. 109 (1).
(5) An individual who is convicted of an offence under this Act is liable to a fine of not more than $50,000 or to imprisonment for a term of not more than
two years less a day, or both, and a corporation that is convicted of an offence under this Act is liable to a fine of not more than $250,000. 2002,
c. 30, Sched. A, s. 116 (5).
• In an effort to foil an effort to unionize
employees, McDonald’s once argued that
people lack of legal capacity to enter contracts
(like contracts for the sale of food) should
undermine the capacity of some of its teenage
employees to sign hold union cards
(Wilson J, Wilson on Children and the Law, § 5.39, 3d ed. 1994).
Lessons learned from
Canadian provincial appeal court rulings on
• ads targeting children must consider “misleading” from the
“objective” (not “subjective”) viewpoint of the ad’s
intended target (i.e., not just by applying an adult’s logical
literal analysis of claims), and
• as interpreted by persons of “average” abilities
appropriate to the circumstances (not by well-informed or
sophisticated persons) (R. v. Cunningham Drug Stores,
1973; R. v. Imperial Tobacco, 1971; R. v. International
Vacations, 1980, p. 284; and R. v. Suntours Ltd., 1974, p.
• THEREFORE To respect these appeal court rulings, it seems
plain that courts should consider developmental
psychology research demonstrating the unique
vulnerability of children to commercial advertising.
And the foreseeable permeability of a
nutrient-based limit on ads
Dec 2012 US Federal Trade
Commission f/u report
ENORMOUS loopholes ($318 B/$534 B=60%)
in nutrient based ad limits
(e.g., w/ brand promos , ads for diet drink, or restaurant venue/trophy foods)
ENORMOUS loopholes ($379 B/$613 B=62%)
in nutrient based ad limits
(e.g., w/ brand promos , ads for diet drink, or restaurant venue/trophy foods)
Who comprise Concerned Children’s Advertisers?
• Nestlé Canada Inc.
• Pepsi-QTG Canada Inc.
• Coca-Cola Ltd.
• McDonald's Restaurants of Canada Limited
• Cadbury Adams Canada Inc.
• McCain Foods (Canada)
• Campbell Company of Canada
• Frito Lay Canada
• General Mills Canada Corporation
• Kellogg Canada Inc.
• Kraft Canada Inc.
• Unilever Canada
• Weston Bakeries Limited
• TELETOON Canada Inc.
• Buena Vista Home Entertainment (Disney)
• Corus Entertainment (YTV & Treehouse)
• CTV Television Inc.
• Global Television Network
• Mattel Canada Inc.
• Mega Blocks Inc.
• Zenith Optimedia Canada
• Hasbro Canada Corporation
For Children's Healthy Active Living Program:
• Hershey Canada Inc.
• Canadian Sugar Institute
• Confectionery Mfrs Assn. of Canada
• Food and Consumer Products Canada
A conservative MP on media literacy for children
(Oct 19, 2006, House of Commons Standing Committee on Health)
• Asking a young child to see through
that with their x-ray eyes, to see that
they're being targeted, is sort of like
child-proofing your kid on the street.
Rather than get the bad guys off the
street, we'll just teach kids how to
recognize the good guys and the bad
• I have to say that I'm a little bit
cynical about that kind of approach.
Obviously there is a role here, and
what we're doing doesn't seem to be
Featured Campaign “B”:
Sodium and calories on restaurant menus
Street intercept study of 8,000 New
Yorkers visiting restaurants
Experts, Health and Citizens’ Groups Call on Governments to Mandate
Nutrition Information on Menus at Outlets of Large Chain Restaurants
full text: http://cspinet.org/canada/pdf/expert_ngo.jointletter.menu-labelling.pdf
Supporters, over the years
(70+ groups have supported various bills in the past)
• Alberta Public Health Association
• Alliance for the Prevention of Chronic Disease
• Canadian Diabetes Association
• Canadian Public Health Association
• Canadian Stroke Network
• Canadian Women’s Health Network
• Canadian Council of Cardiovascular Nurses
• Centre for Science in the Public Interest
• CancerCare Manitoba
• Childhood Obesity Foundation
• Coalition québécoise sur la problématique du
• DAWN (DisAbled Women's Network) Ontario
• Dietitians of Canada
• Fitness Industry Council of Canada
• Hypertension Canada
• Ontario Home Economics Association
• Physicians for a Smoke-Free Canada
• Prevent Cancer Now Board
• Public Health Physicians of Canada
• Québec en Forme
• Sport Matters Group, Ottawa, ON
• University of Ottawa Heart Institute
• Dr. Yoni Freedhoff, MD CCFP Dip ABBM, Medical
Director, Bariatric Medical Institute
• Leslie Beck, RD, Leslie Beck Nutrition Consulting
• Dr. Kim Raine, PhD, RD CIHR/HSF Applied Public
• Dr. Norm Campbell, HSFC CIHR Chair in
Hypertension Prevention and Control
Other Groups Backing Gelinas Bill
Ontario Medical Association
Heart and Stroke Foundation (Ontario)
Registered Nurses Association of Ontario
Dr. David McKeown, Medical Officer of Health
since June 2013
starting October 17th
Consultation on Food Labelling
…but “out of focus”
• nutrition labelling and health
• And, “The CFIA will introduce a
web-based label verification
tool that encourages
consumers to bring validated
concerns directly to companies
and associations for
2012 Federal Budget, Budget
Plan. Available at:
What’s next for menu labelling?
• Menu labelling by-law proposal before Toronto City
Council February 19-20, 2014
• Bill 59, Healthy Decisions for Health Eating Act, a debate
and vote in Ontario legislature around February 18, 2013
• Ottawa City Council/Board of Health?
• Health Canada led “Federal Provincial, Territial Task
Force on Nutrition Information in Restaurants and
Foodservice Establishments” (unpublished TOR) to
recommend in 2015
• CFIA food label modernization consultation concludes
Championing Public Health Nutrition
Ottawa, November 2014
Centre for Science in the Public Interest
Suite 2701, CTTC Bldg.
1125 Colonel By Drive
Ottawa, Ontario K1S 5R1