We all talk of the rapidly-changing world we live in and how that change is creating opportunities for Sri Lanka’s young and old – the digital age, the Internet of Things, AI, so on and so forth – but there is a flip side to all of this change, and an unchecked impact on our public health is part of it.
Non-Communicable Diseases (NCDs), also known as chronic diseases, are increasing exponentially in prevalence, partly because of the change that technology and its rapid advancement have wrought in all aspects of our lifestyles. NCDs are diseases that are not transmissible directly from one person to another. They tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioural factors. The main types of NCDs are cardiovascular diseases (such as heart attacks and strokes), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes.
Globally, according to the World Health Organization (WHO), NCDs kill 41 million people each year, equivalent to 71% of all deaths globally. More than 15 million of these deaths are of those between the ages of 30 and 69; 85% of these ‘premature’ deaths occur in low- and middle-income countries like Sri Lanka (of the total death toll attributed to NCDs each year, it has been found that 31.4 million happen in low- and middle-income countries).
ChildFund Sri Lanka: Strengthening regulatory framework and multi-stakeholder collaboration to prevent NCDs
In Sri Lanka, studies done in major cities have shown that 9% of Sri Lankan children are overweight or obese – an alarming statistic because being overweight or obese as a child greatly increases the risk of suffering from NCDs. In part, this statistic can be attributed to the misconception in society, especially when it comes to young children, that a fatter child is healthier, which in turn affects eating patterns in childhood, and, combined with the widespread availability of high-calorie, high-sugar, high-salt, and high-fat foods, contribute to obesity in children, putting them at greatly increased risk for developing NCDs as they grow.
In 2021, ChildFund Sri Lanka (CFSL) partnered with the Ministry of Health (MOH) for the ‘Global RECAP: Promoting Healthy Diets and Physical Activity in Sri Lanka’ project, which aims to conduct social mobilisation and community education activities towards minimising the occurrence of Non-Communicable Diseases through effective regulatory measures and promotion of healthy diet and physical exercise.
Global RECAP is a collaborative programme between the International Development Law Organization (IDLO), Canada’s International Development Research Centre, and the World Health Organization (WHO). Global RECAP is part of the ongoing global efforts to enhance multi-stakeholder engagement and dialogue to address Non-Communicable Diseases.
Brunch spoke to RECAP Project Consultant and Ministry of Health Environmental Health, Occupational Health and Food Safety former Director and Deputy Director-General Dr. Lakshman Gamlath for more on NCDs in children, and how Sri Lanka mitigates NCDs in both children and adults through food safety regulation and advertising mechanisms.
Food and safety regulations in Sri Lanka
Dr. Gamlath explained that Sri Lanka’s food industry is controlled by the Ministry of Health under Food Act No. 26 of 1980 with the Director-General of Health Services (DGHS) serving as the chief food authority and the Deputy Director-General of Environmental Health, Occupational Health and Food Safety (EOHFS) functioning under the DGHS as the head of food control through the Food Control Administration Unit (FCAU). The FCAU is responsible for import control, domestic control of food, and issuing export certificates for exporting food items.
“The Food Act No. 26 of 1980, within the Act itself, lists out certain parameters on the type of food one cannot import, manufacture, distribute, or sell,” Dr. Gamlath said, adding: “This includes any food that has some naturally occurring or added injurious substance, any decayed or repugnant component, or adulterated products.” Gazetted regulations under the Food Act also cover which additives, colours, and preservatives are permissible to use in food products regardless of the size or scale of a food business.
Noting that there are over 30 regulations enforced under the Food Act, Dr. Gamlath also pointed out that these include regulations focused not just on the manufacture of food but on labelling and advertising (with a long-term view on educating consumers on healthy food practices and preventing the misleading advertising of products that are injurious to health), and hygiene regulations for any kind of food establishment, from temporary food stalls to large-scale eateries or food manufacturers, that set out hygienic practices around food.
The Food Act and the FCAU also set standards for the quality of food, from manufactured and processed foods to raw locally-produced foods like black peas, brown sugar, eggs, cooking oils, and so on, using global standards and adapting this to the Sri Lankan context.
Intervening in the spread of NCDs through food safety regulation
Explaining that one of the chief factors that contribute to NCDs is diet, with high-calorie, high-sugar, high-salt, and high-fat foods being most detrimental to long-term health, Dr. Gamlath noted that the FCAU, over the decade, has embarked on several interventions through food regulation mechanisms to help mitigate the prevalence of NCDs among Sri Lankans.
One such intervention, spearheaded by Dr. Gamlath himself as EOHFS Deputy Director-General, is what he calls the traffic light system – a colour-coded system first introduced in 2016 that focused on sugar content in beverages, especially fizzy beverages. “In some sugary drinks, it doesn’t give a very sugary taste although they contain high amounts of sugar, so to highlight this and make people aware, we introduced the colour-coding system so consumers could look at the bottle and see how much sugar there is in the bottle.”
One result of the colour-coded system was that many beverage companies scaled down the amount of sugar in their products to come in just under the red rating, resulting in a general influx of relatively healthier beverages in the market (these beverages do still pose a significant risk to health if consumed heavily. 10% to 15% of Sri Lankans are diabetic, and excess sugar consumption is a key factor in the high incidence of this NCD).
In 2020, the traffic light system was expanded to include solid food, taking into account not only sugar but also fat and salt, three major nutrients that can be the culprits behind many NCDs if consumed irresponsibly. “This system was delayed slightly because of Covid-19, but now if you take any packaged food, you will see this colour-coding and can decide if it’s something you want to eat or not,” Dr. Gamlath said.
Another key intervention put forward by the FCAU during Dr. Gamlath’s tenure was the sugar tax where any drink with more than 6 g of sugar per 100 ml had to pay a tax of 30 cents per additional gramme of sugar. This also served to encourage companies to reconsider the amount of sugar in their products.
Children, food safety regulations, and the media
Globally, many countries have adopted special regulations targeted at children and their diets, but in Sri Lanka, Dr. Gamlath explained, there are no child-specific food safety regulations. “Countries like Taiwan and South Korea, for example, have defined what unhealthy food is, instituting cut-off points for too many calories or excess salt or fat in foods for children, and also limit advertising foods that are unhealthy during times when children are likely to be watching,” Dr. Gamlath said. He further noted that food companies also have special criteria they need to meet before being able to promote their products in a setting where they might be exposed to children. In the case of Chile, celebrities are not even allowed to endorse food products for children due to the risk of influencing children to purchase something that is unhealthy.
“We don’t have such regulations in Sri Lanka yet. The framework for such regulations was done in 2018 and was to come into effect in 2021, but it is not yet out. The new regulations give some general conditions for any food advertising (print, social media, advertising agency, or companies advertising directly), requiring prior approval from the MOH and amending labels as needed before advertising,” Dr. Gamlath said. “Another new clause looks at controlling unethical marketing towards sensitive populations and banning advertisements from directly representing a pregnant mother, lactating mother, or underaged child.”
Noting that Sri Lanka has a propensity for false advertising of food products, most recently the number of immunity-boosting food products that flooded the market during and before the pandemic, promoting specific products as improving childrens’ cognitive function or improving their intelligence from within the womb prenatally, Dr. Gamlath said that many Sri Lankan products come with claims that are unsubstantiated and hence not approved by the FCAU, which is a statutory requirement.
Moving forward for a healthier tomorrow
Concluding his chat with Brunch, Dr. Gamlath said that the lack of regard for food regulations in Sri Lanka is an issue that needs to be resolved on many fronts.
Administratively, from the FCAU and the Ministry of Health, there is corrective action needed to enforce these regulations more effectively. These include revisions to the Food Act to increase fines and other punitive measures, as well strengthening the implementation mechanism of enforcing regulations, which currently relies on Public Health Inspectors (PHIs) for implementation in the field. These PHIs pay attention to food safety regulations in addition to looking into things like dengue prevention, environmental health, general public health for their area, and, of course, over the last two years, responding to the pandemic.
Dr. Gamlath called for dedicated PHIs at the MOH level to look into food safety to ensure regulations are being followed and standards are being met. He also called for improving laboratory facilities, noting that there are only four labs in Sri Lanka under the MOH where food testing can take place, and of these, more than one is severely under-equipped.
Additionally, he noted that food producers and manufacturers also need to step up and take a larger responsibility in ensuring that the products they put out for public consumption are nutritionally healthy and hygienically produced, adding that more and more companies, especially now, are compromising quality to meet their bottom line.
Finally, Dr. Gamlath called for the advertising industry to make conscious efforts to market responsibly, noting that, by and large, he has found the local advertising industry to be irresponsible, and while he understands that the advertising space is very competitive and the food industry market even more so, everyone highlighting their products with unjustified and unsubstantiated claims only serves to harm the public’s overall health, both in the short- and long-term.
