New EU Trade Rules Threaten the health of UK Babies 20 July 2006 At a closed meeting of bureaucrats in Brussels on Wednesday the 19 July, the UK  disappointed health campaigners by voting to accept new European legislation drawn up by the European Commission covering the marketing and composition of baby milks  - legislation which the UK, and several other EU Member States had consistently criticised as inadequate. (1)   The Minister for Public Health, Caroline Flint, immediately issued a statement suggesting the new Directive would improve health protection (2) but failed to highlight the sections which health campaigners fear will make health protection significantly worse. Patti Rundall, Policy Director of Baby Milk Action, says: “The decision to approve this faulty, inadequate and dangerous Directive shows that the consultation procedures conducted by the Food Standards Agency and the European Commission mean very little.  The UK Government did try to improve the Directive, but  the way the process is  set up by the Commission  makes it extremely difficult to  achieve changes that protect health rather than the interests of the multi billion dollar baby food industry.  The decision to vote Yes has saddened and worried UK and European health organisations,  including the Baby Feeding Law Group, which includes the Royal College of Nursing, the Royal College of Midwives and the Royal College of Paediatrics and Child Health,  and represents  over half a million health professionals. All  were calling for  a NO vote so that european babies could have the protection called for by the many UN Resolutions  on infant feeding." (3)    The day before the meeting the UN Special Rapporteur on the Right to Food sent an emergency message to the meeting in Brussels calling for the Directive to be strengthened.  All the health, consumer and development bodies consulted by the Commission criticised the proposals and warned that it could do harm to public health. The sections on labelling are not in line with the Commission’s own scientific advisory body, the Scientific Committee for Food and several provisions  allow marketing tactics that are known to mislead parents and boost sales at the expense of breastfeeding. (4)   The European Commission has for decades protected the interests of the baby food industry and has only introduced safeguards because of public exposure and the censure of the European Parliament which, during the 1980s, rejected Commission proposals three times.  Since 1989 the rules have changed and the new proposals  do not have to go before the EU Parliament but are discussed in closed meetings of ‘experts’.  It is significant that many  countries are represented at these meetings by Agriculture and Food Standards Departments, rather than by Health Departments, so the finer details of why such strategies are harmful to health have not been explored. The new Directive could endanger the health of artificially-fed infants, because it allows companies to introduce new ingredients before they have been authorised as safe.  It also allows them to promote follow-on milks and  include promotional claims about ‘optional’ ingredients. These claims imply that the products  will make babies cleverer or protect them from infection. There can be no health advantage in using breastmilk substitutes and the World Health Assembly and other UN bodies are calling for parents to be alerted to the fact that powdered infant formulas  are not sterile and could contain disease-causing bacteria. (About 10-14% of powdered baby milks contain such bacteria according to studies). (5) The Directive could also have a damaging impact on policy setting in Third countries, conveying the false impression that harmful marketing practices are approved by Europe’s health community.   Because of the new rules, EU health services will have to pick up the costs of the ill health resulting from bottle feeding in both mothers and babies: increased incidence of breast cancer, ovarian cancer, diabetes, bone fractures in women and increased risk of infections, diarrhoea, diabetes, etc in babies. The Directive will also undermine the efforts of the European Commission and Member States to counter the obesity epidemic. Epidemiological evidence strongly suggests that breastfeeding represents an ideal window of opportunity for the prevention of overweight and obesity. In 1995 when in opposition Tony Blair criticised the Tory Government for putting “commercial interests before infant health”  his Government has now done the same.  In 2002 the UN Committee on the Rights of the Child called on the Government to implement the International Code of Marketing of Breastmilk Substitutes, adopted by the World Health Assembly in 1981 to protect breastfeeding and to ensure breastmilk substitutes are used safely when necessary. The Baby Feeding Law Group, an ad-hoc group of 17 leading health professional and lay organisations, (3) will now increase its pressure  on the Government to  fulfill its promises and bring UK legislation into line with UN requirements, despite what has happened with the Directive.     The manufacturers also have a responsibility to do this, and Article 11.3 of the International Code calls on them to abide by the Code i ndependently of government action: “Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them.” Examples of the type of advertising the Government has voted to legitimise can be seen on the website of the Baby Feeding Law Group in the monitoring section. Notes: In a Parliamentary answer to Lynne Jones MP, the Public Health Minister, Caroline Flint MP, stated on 5 July : http://www.publications.parliament.uk/pa/cm200506/cmhansrd /cm060706/text/60706w1487.htm#0607077003125 “The Department is working with the Food Standards Agency to continue to press for changes to the recast European Union directive on infant formula and follow-on formula advertising. The Department also intends to review, later this year, the United Kingdom regulations on infant formula and follow-on formula advertising, a commitment set out in the “Choosing Health—Making healthy choices easier” White Paper.” In its Public Health White Paper, Choosing Health, the Government stated: “Further action will include the review of the Infant Formula and Follow-on Formula Regulations (1995) with a view to further restrict the advertising of infant formula. We will continue to press for amendments to the EU Directive on infant formula and follow-on formula.” Health organisations have been calling for a ban on follow-on milk advertising. On 6 July, Public Health Minister, admitted in a Parliamentary answer to Lynne Jones MP (who has tabled an EDM calling for action to implement the Code and Resolutions at UK, EU and international level): http://www.publications.parliament.uk/pa/cm200506/cmhansrd/ cm060705/text/60705w1482.htm#06070623005163 “The Department commissioned a survey of pregnant women and women with young children in August 2005 to establish whether there was any confusion among consumers relating to advertising of follow-on formula milks. The results of the survey suggest that there is some confusion among consumers. Of the total respondents surveyed 39 per cent., stated they had seen infant formula advertising, rather than follow-on formula, which is not allowed under European Union law.” In 1995 when the Tory government introduced the UK law, Tony Blair MP, then leader of the opposition, tabled a motion in Parliament stating: “That this House is alarmed at the decision taken recently by Health Ministers to put commercial interests before infant health when it refused to ban the advertising of infant formula in the United Kingdom; is aware that such a decision is contrary to all its statements in support of an advertisement ban over the last 13 years, and contradicts also the advice given to it from major health bodies including the British Medical Association, the British Paediatric Association, and the Royal College of Midwives; and calls upon Her Majesty’s Government to rethink its approach instead of simply responding to UK baby milk companies’ promotions. Caroline Flint, Statement to the Press, 19th July 2006.  In attempting to justify the decision to support the Directive Caroline Flint claimed:Analysis of company advertisements finds, however, that they are promotional in nature and often make health and nutrition claims that are not supported by research. A Department of Health survey in 2004  found that 34% of mothers incorrectly believed that modern infant formula milks are very similar or the same as breast milk (see ‘Myths stop women giving babies the best start in life’ http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/ PressReleasesNotices/fs/en?CONTENT_ID= 4081944&chk=b8wDo%2B) http://www.babyfeedinglawgroup.org.uk/advocacy.html   The UK Baby Feeding Law Group is an adhoc group of health professional and lay organizations working to bring UK and EU legislation into line with the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA resolutions. Its members are: The Association of Breastfeeding Mothers, the Association for Improvements in the Maternity Services, the Association of Radical Midwives, Baby Milk Action, the Breastfeeding Network, the Food Commission, the Community Practitioners and Health Visitors’ Association, Lactation Consultants of Great Britain, La Leche League (GB), Midwives Information and Resource Service, the National Childbirth Trust, the Royal College of Midwives, the Royal College of Nursing, the Royal College of Paediatrics and Child Health and the Unicef UK Baby Friendly Initiative. The claims permitted include several nutrition claims about long-chain fatty acids and other ingredients and  a disease-risk reduction claim relating to a “reduction of risk of allergy to milk proteins.”   ‘Hypoallergenic’ claims have not been permitted on infant formula labels in the US 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.’ The claim was refused once more by the US Food and Drug Administration in May 2006 on the grounds that there is no credible evidence to support it The allegedly falsified research of Canadian scientist, Dr Ranjit Chandra, which has been used as the basis of many of the ‘hypoallergenic claims’, was the  subject of three Canadian Television exposures in February this year. http://www.dairyreporter.com/news/ng.asp?id= 67769-nestle-infant-formula-allergy-symptoms http://seattlepi.nwsource.com/health/ 1500AP_Nestle_Infant_Formula.html http://www.cfsan.fda.gov/~dms/qhcwhey.html The following article shows the impact on claims about long-chain fatty acids. Baby formula  boom boosts Martek sales  By Clarisse Douaud http://www.nutraingredients-usa.com/redirect.asp?idc=11298 6/7/2006 - Increased  international sales from a thriving infant formula market drove up Martek's  net income by almost 85 percent in Q2, and new deals point to positive  results for the remainder of the year. A MORI survey commissioned by UNICEF and NCT in 2005 similarly found that follow-on formula advertising served to promote infant formula. In the survey 60% of pregnant women and new mothers said they had seen infant formula advertising (which is illegal) when they had most likely seen follow-on formula (which the Government has voted to legitimise). Again mothers had been misinformed about formula: “a third of women who had seen formula advertising said that the message conveyed was that infant formula is 'as good as' or 'better than' breastmilk.” (See http://www.babyfriendly.org.uk/mailing/updates/ research_update_20050919.htm) The Codex Working Group Meeting on Infant Formulae, Ottawa, Canada, May 15-17, 2006, considered again the draft Code of Hygienic Practice.  A chapter "Control measuresfor safe preparation of formula" was added.  A text was agreed: "Powdered infant formula is not a sterile product and may be contaminated with pathogens that can cause serious illness.  Correct preparation and handling reduces the risk of illness" WHA RESOLUTION 58.32 urged Member States (3) “to ensure that clinicians and other health-care personnel, community health workers and families, parents and other caregivers, particularly of infants at high risk, are provided with enough information and training by health-care providers, in a timely manner on the preparation, use and handling of powdered infant formula in order to minimize health hazards; are informed that powdered infant formula may contain pathogenic microorganisms and must be prepared and used appropriately; and, where applicable, that this information is conveyed through an explicit warning on packaging” http://archive.babymilkaction.org/press/press4jan06.html    In a letter to health professionals in 2002, the US Food and Drug Administration (FDA) refers to a 1988 study from several countries which found E. sakazakii in 14% of samples of powdered infant formulas (note 5). A 2004 study carried out by researchers at Nottingham Trent University found disease-causing bacteria, including E.Sakazakii, in 8 out of 82 packs powdered infant formulas (note 6) Unfortunately it seems that any level of E.Sakazakii contamination can lead to infections. (note 4). http://www.who.int/foodsafety/publications/micro/en/es.pdf International Food Safety Authorities Network, INFOSAN, Information Note No. 1/2005, Enterobacter sakazakii http://www.who.int/foodsafety/micro/meetings/feb2004/en