The EU/US Conference, Good practices: Action on Diet, Physical Activity and Health. Brussels Press release 12 May 2006. Click here to download the Consensus Statement from US and EU citizens groups on marketing of foods to children “All too often the education process is entrusted to people who appear to have no understanding of industry and the path of progress...The provision of education is a market opportunity and should be treated as such" European Round Table of Industrialists, 1988 "Artificially fed infants consume 30,000 more calories than breastfed infants by 8 months of age - equivalent to 120 Mars bars - 4 a week." Human Lactation 1999 (Note 1) "From the moment of conception, through the pregnancy, birth and beyond, a mother and her child represent a valuable commercial opportunity." Hunter1997 PR Week IBFAN is an active member of the European Commission’s Platform for Action on Diet, Physical Activity and Health and is appreciative of the European Commission’s efforts to address the problem of diet-related illnesses. However, we have several concerns, including: Self-regulation is not sufficient: Along with many public interest NGOs, and based on its 27 year experience of monitoring the baby food industry, IBFAN not believe that self-regulation and individual action will be sufficient to address the problem. The promotion of such measures should not divert attention from the more permanent solutions, such as legally enforcable and industry wide controls of marketing and should not be presented as a model for other countries. The promotion of partnerships : The Plenary provides a useful forum for discussions between different stakeholders, but it is also clearly putting pressure on public interest NGOs to enter into partnerships with the food industry. While the NGOs appreciate the positive steps taken by some companies, it is essential that their commitments are very carefully monitored, independently on a long-term basis. Partnerships inevitably create conflicts of interest and could threaten the independence of the NGOs, undermining public confidence in their monitoring. Public opinion has, so far, been one of the main driving factors behind any improvements in marketing. To safeguard public health, NGOs must be free to speak out unambiguously. Promotion of breastmilk substitutes: The Commission is not looking sufficiently closely at its own policies on the marketing of infant foods. The EU Directive on infant formula currently being pushed through by the Commission (DGSANCO) contains harmful provisions, including health and nutrition claims, which will boost market for breastmilk substitutes and undermine infant health in the EU and globally. Calls from the UK and several Member States for the proposals to be strengthened have so far been ignored by the Commission and a vote will be taken at a Standing Committee meeting on June 26th. IBFAN has proposed that the Platform endorses breastfeeding as the optimum nutrition for infants and that all promotion of breastmilk substitutes is halted. Industry-funded education: Many of the commitments on the Commission website include industry-funded education programmes, including media-literacy schemes such as Media Smart. The commitments are not screened before they are posted to see if they are evidence-based, relevant and in conformity with internationally agreed recommendations such as the Convention on the Rights of the Child or the International Code of Marketing of Breastmilk Substitutes and subsequent relevant resolutions (which all EU Member States endorse and which urge governments to avoid conflicts of interest in the provision of infant feeding information). Materials which have been sponsored by companies with an interest in selling products to children (or parents) present an even more complex problem than brand promotions because they blur the boundaries between advertising, marketing and independent information and can subtly distort the curriculum in favour of business interests . To protect children’s rights to be protected from exploitation schools should be commercial free environments. Companies have a legal duty to maximise profits for their shareholders and any investment – in education or anything else – must show a return, in either the short or long term. Commercial sponsorship of this nature is not charitable. Although some materials are relatively brand free, most promote brands and/or companies and all subtly influence the reader’s understanding of what is and is not a healthy diet, at the same time diverting attention away from the unethical marketing of the sponsor. The image of responsibility conveyed, encourages consumers to feel ‘safe’ with a certain companies’ brands. The baby food market was created and maintained through materials which persuaded mothers to trust companies and millions of infants have paid the price. Should baby food manufacturers give infant feeding and parenting skills ? The safety of novel foods and processes: With increasing emphasis on reformulation of products, it is essential that consumers are not misled about the safety and value of the ingredients used to replace salt, fat and sugar. Many of these ingredients are the subject of fierce controversy. If the scientific community disagrees about whether Aspartame is a cancer risk, how can a soft drinks manufacturer be expected to provide an objective view (note 2). Because of such schemes policy makers and teachers can be persuaded that it is safe to allow companies into the classroom. IBFAN is urging that the Commission does not increase the this risk of this happening by allowing food-industry-sponsored education materials to carry the Platform logo. A marketing code for foods for children could provide some structure and guidance on best practice and help ensure that children are not exploited, as called for in the Convention on the Rights of the Child (CRC) (note 3). The USA and breastfeeding The United States and the European Commission both have a long history of protecting the interests of the infant feeding industry and blocking measures to halt the commercial promotion of artificial feeding. The USA was the only country to vote against the International Code in 1981 and because of US objections, it was adopted as a recommendation rather than a regulation. (The Code was, nevertheless, adopted as a ‘minimum requirement’ for ‘all’ Member States, to be adopted ‘in its entirety.’ ) Although there are many programmes to support breastfeeding in the United States the Government has never taken action to stop the commercial promotion of artificial feeding, arguing as they do over junk food promotion. As a consequence the efforts being taken to support breastfeeding mothers and ensure that parents are properly informed are continually undermined. Indeed in 2004, under pressure from two formula companies, the US Department of Health decided to remove information about the increased risk of leukemia and diabetes if children are not exclusively breastfed for 6 months from the messages and adverts used during the National Breastfeeding Awareness Campaign. This was not because of lack of evidence, but because the companies argued that it might make mothers feel guilty. However, as evidence has mounted about the damage caused by artificial feeding, the US Government has increasingly acknowledged the importance of breastfeeding and the need to protect it. For example: The HHS Blueprint for Action on Breastfeeding (2000) acknowledged the negative effect of marketing The US Surgeon General’s Fact Sheet, Overweight and Obesity: A Vision for the Future (2005) identified breastfeeding as one of the 15 national priorities for immediate action: “Everyone must work together to:…..Educate all expectant parents about the many benefits of breastfeeding. Breastfed infants may be less likely to become overweight as they grow older. Mothers who breastfeed may return to pre-pregnancy weight more quickly .” (note 4). According to the U.S. Department of Agriculture (USDA), the U.S. would save a minimum of $3.6 billion in health care costs and indirect costs, such as parents’ lost wages, if breastfeeding increased. Studies have shown that promoting breastfeeding has the potential to save or delay 720 postneonatal deaths in the United States each year. Breast-fed babies are 21% less likely to die of sudden infant death syndrome (SIDS), infectious diseases and even injuries than artifically fed infants (note 5). Nearly half of infants born in the U.S. receive free food and infant formula through the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and WIC recipients generally have lower breastfeeding rates. A US Government Accountability Office report in February 2006 (note 6) found that “Infant formula marketing targets non-WIC mothers and also reaches WIC mothers. Some of these marketing efforts use the trademarked WIC acronym in promotional materials. Although FNS requires states to restrict this practice in their WIC contracts, most states do not… Amajority of studies we reviewed that examine giving free formula samples to mothers at hospital discharge found lower breastfeeding rates among both WIC and non-WIC mothers. However, little is known about the impact of most types of marketing." The US position on claims. Although health claims and endorsements appear on many food products in the USA, ‘hypoallergenic’ claims have not been permitted on infant formula labels since 1989 when nine US authorities took legal action to stop Nestle Carnation making these claims. Several infants had suffered anaphylactic shock after being fed Nestlé formula which had been advertised as  ‘hypoallergenic.’ Earlier this year Canadian Television carried an exposé on three consecutive nights about the falsified research of Canadian scientist, Dr Ranjit Chandra, which had been used by Nestlé and other companies to support their claims. On Friday 12th May 2006 the Food and Drug Administration in the USA rejected a new attempt by Nestle USA to carry a reduced risk to allergy claim on its infant formulas (a petition filed in 2005 before the Canadian expose).   In a letter posted on its website, the FDA denied Nestlé’s petition saying there was no credible evidence to support the company's claim (note 7). The European Commission Ever since 1981 when the International Codeof Marketing of Breastmilk Substitutes was passed there have been calls (from MEPs, NGOs, UN and health bodies and thousands of individuals) for it to be incorporated into a Directive for Europe. Three different proposals which favoured industry were put forward by the Commission and all were rejected. Eventually, however, the Commission made several concessions which specifically allowed Member States to prohibit advertising of infant formula and up until now, Member States have been able to carry out their obligations under the Code. In 2005 the Commission drafted new proposals for a recast version of the EU Directive on infant formula. But instead of bringing EU legislation closer to the requirements laid out by the World Health Assembly, the proposals took them further away - opening the door to one of industry’s most effective marketing strategies – the use of health and nutrition claims to promote ‘optional’ ingredients. Claims on breastmilk substitutes are always misleading because they falsely imply a health advantage and are highly promotional. IBFAN and the leading health bodies in Europe maintain that it is unethical to promote a double standard in this way. If an ingredient is essential for health and has been shown to be safe through independently-funded and systematically-reviewed research, it should be a legally required ingredient available to all infants. IBFAN members from 26 countries have written to Commissioner Kyprianou, calling on him to ensure that the EU’s aim to become the most competetive economy in the world by 2012, does not take precendence over the protection of health, the environment and human rights and to ensure that the EC Directive enables and empowers Member States to fulfill their obligations to protect infant health. The UK The UK Government provided a dossier of evidence to the Commission showing that the promotion of breastmilk substitutes (including follow on milks) undermines infant health and misleads parents (note 8). The Commission has so far refused the UK’s plea to include a specific provision in the Directive allowing Member States to ban follow-on formula promotion, arguing that to do so would be a barrier to trade. The UK Government’s response to the European Commission’s Green Paper Promoting Healthy Diets and Physical Activity: a European dimension for the prevention of overweight, obesity and chronic diseases, states: “The UK Government continues to recommend and promote breastfeeding as the best nutrition for infants in the first six months. The Commission can play an important role in supporting this approach by endorsing policies aimed at improving exclusive breastfeeding and duration on an EU-wide basis, in accordance with the “Blueprint for Action” and the WHO Global Strategy on infant and Young Child Feeding…..A national Healthy Start scheme is currently being phased in ……Core elements of the scheme include promotion of breastfeeding…..the Commission should aim to encourage the adoption of the essential elements of early years’ nutrition across the EU and look at ways to support national actions. Breastfeeding, health, obesity and food related diseases Scientific evidence has consistently demonstrated that artificial infant feeding increases mortality rates, increases rates for illnesses such as infectious, chronic and auto-immune diseases, offers less than optimal development and growth and lowers cognitive and visual development. Epidemiological evidence - 17 of the 21 studies – strongly suggests that breastfeeding represents an ideal window of opportunity for the prevention of overweight and obesity. Once a child becomes obese, it is quite likely that s/he will remain obese as an adult. Breastmilk could influence the development of a taste receptors profile encouraging a preference for lower energy diets later on in life. In April 2006 WHO published new growth standards, the result of a seven-year WHO Multicentre Growth Reference Study of 8,440 children in 6 countries. The study showed that breastfeeding should be the biological  “norm” and the breastfed infant the standard for measuring healthy growth. Sound early nutrition seems to be more influential in child development than genetics or ethnic origin. The USA Centre for Disease Control and Prevention (CDC) identified decreased television viewing and breastfeeding promotion as the only two potential, cost-effective interventions that can be put into place immediately to deal with the childhood obesity epidemic (note 10) . Since the late 1970s the global network of citizens groups, IBFAN, has been working to remove the obstacles to breastfeeding, including the commercial promotion of breastmilk substitutes. Because of the work of IBFAN and UNICEF over 70 governments (over half the world) now have laws based on the International Code of Marketing of Breastmilk Substitutes which was adopted by the World Health Assembly in 1981. Along with the other measures to support breastfeeding, this is feeding through to increases in breastfeeding rates 4% each year in Brazil. Globally, exclusive breastfeeding rates have risen by 15% since 1990. For more information contact:Patti Rundall, Policy Director, Baby Milk Action, 34 Trumpington St, Cambridge, CB2 1QY Tel: 01223 464420, Mobile: 07786 523493 prundall@babymilkaction.org www.ibfan.org www.babyfeedinglawgroup.org.uk Notes Riordan and Aerbach Breastfeeding & Human Lactation Jones and Bartlett 1999 FDA Statement on European Aspartame Study, May 8, 2006 http://www.ramazzini.it/eng/fondazione/ eventidettagli.asp?id=292 http://citizenship.coca-cola.co.uk/pdf/ASPARTAME.pdf Baby Milk Action’s education pack Seeing through the Spin ( archive.babymilkaction.org/spin) http://www.surgeongeneral.gov/topics/obesity/ calltoaction/fact_vision.htm Breastfeeding and the Risk of Postneonatal Death in the United States Aimin Chen, MD, PhD; and Walter J. Rogan, MD PEDIATRICS Vol. 113 No. 5 May 2004 Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect against Misuse of WIC Name US Government Accountability Office GAO, February 2006 FDA rejects Nestle bid on health claim, Associated Press, Seattle Post, May 12, 2006 “Nestle, in the 2005 petition filed with the FDA, sought permission to claim that feeding an infant 100 percent whey-protein partially hydrolyzed formulas may reduce the risk of common food allergy symptoms, particularly skin rashes, when substituted for formulas made from whole-protein cow's milk.” http://seattlepi.nwsource.com/health/ 1500AP_Nestle_Infant_Formula.html http://archive.babymilkaction.org/press/press3feb06.html http://archive.babymilkaction.org/press/press28july04.html http://www.cfsan.fda.gov/~dms/qhcwhey.html archive.babymilkaction.org/press/press19sept05.htm http://www.who.int/childgrowth/en/ The children from Brazil, Ghana, India, Norway, Oman and the USA were all exclusively breastfed and their mothers followed health practices such as not smoking during  and after pregnancy.  The charts show that all children across all regions can attain a similar standard of height and weight and development with correct feeding practices, good healthcare and a healthy environment. Dietz WH. Breastfeeding may help prevent childhood overweight. JAMA. 2001; 285:2506-