Issue 41: November 2008
(continued)

Contents

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World Health Assembly

New UN Resolution tackles intrinsic contamination

In May 2008, representing Save the Children, we joined the International Baby Food Action Network (IBFAN) and Consumers International team at the 61st World Health Assembly in Geneva to help the adoption of new Resolutions.

Once again, the US took an opposing position, but thanks to the support of New Zealand, Palau, Africa and the Middle East, important resolutions were adopted which will protect infant and young child health, and help ensure that parents are properly informed. The some key points are given below:

• The Resolution on Infant and Young Child Nutrition (WHA 61.20), the13th since the International Code was passed in 1981, focussed on the risk of intrinsic contamination of powdered formulas and the need for warnings, safe storage and preparation, the importance of breastfeeding in relation to food security and the need to monitor and enforce the Code and its Resolutions “while keeping in mind the WHA resolutions to avoid conflicts of interest.”

• For the first time the Resolution on the Global Immunization Strategy (WHA 61.15) urged Member States: “to strengthen efforts to protect, promote and support early and effective breastfeeding, in order to boost the development of infants’ overall immune system.” We don’t know how the word ‘effective’ got in, but trust that it refers to exclusive and sustained breastfeeding!

• Resolution WHA 61.14 adopted the Plan of Action for the Prevention of Noncommunicable Diseases, which calls on Member States: “to promote and support exclusive breastfeeding for the first six months of life, and promote programmes to ensure optimal feeding for all infants and young children.”

• The Resolution on Monitoring of the Achievement of the Health-related Millenium Development Goals (WHA 61.18) cites malnutrition as a social determinant that underpins mortality and morbidity.

For the above WHA Resolutions see www.who.int/gb/e/e_wha61.html

For other important resolutions see the IBFAN website, in particular: WHA 58.32 on micronutrients and the importance of “safe and adequate amounts of indigenous foodstuffs and local foods ..” WHA Res 49.15, 55.25 and 58.32 address conflicts of interest.

WHO and conflicts of interest

Meanwhile some important principles regarding conflicts of interest were raised in the discussion on Strategies to Reduce the Harmful use of Alcohol (WHA 61.4)

Dr Ala Alwan, the Assistant Director General for Noncommunicable Diseases and Mental Health supported Member States concerns about the involvement of the alcohol industry and emphasized “the need to avoid any perception of conflict of interest.”

This position was supported by WHO’s Legal Counsel who said: “The set of Guidelines on Interaction with Commercial Enterprises to Achieve Health Outcomes is the codification of the best practices so that interaction with commercial enterprises does not impact negatively on the integrity and legitimacy of WHO’s normative functions.”

The final resolution separate collaboration with Member States from consultation with other parties such as industry. For the Guidelines see:
http://ftp.who.int/gb/archive/pdf_files/EB107/ee20.pdf

• We contributed to the UK Department for International Development (DFID) consultation on its new HIV strategy, Achieving Universal Access - the UK Strategy for halting and reversing the spread of HIV in the developing world, which has improved the section on breastfeeding.

• In July Gov.Net Communications Ltd hosted a conference Health of the Nation 08 sponsored by Nestlé. Despite its name, GovNet is a private company and not a government body. According to the Food Magazine (Jun 08) NGOs would have been charged £15,000 to run to two-hour seminars!

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Public Private Partnerships - whose interests do they serve?

Public-Private-Partnerships (PPPs) and UN Business Partnerships (UNBPs) - in the form of satellite bodies that are not democratically governed or accountable - are being promoted as innovative market-led solutions to just about everything from development to climate change to health.

But whose interests do these bodies really serve?

DANONE - since its takeover of NUMICO, the world’s second largest baby food company - now sits on the governing body of the Global Fund for Improved Nutrition (GAIN) - a UNBP. But there is no mention of Danone’s interest in baby foods on the GAIN website nor any mention that it is a systematic Code violator. GAIN claims to be working to improve nutrition by building markets for fortified foods in the developing world and has now launched a profect on infant and young child nutrition.

In concern about this unacceptable conflict of interest, 53 experts from 24 countries, attending the World Alliance for Breastfeeding Action (WABA) workshop in Penang, Malaysia in October have written to WHO and UNICEF calling on them to reconsider their partnership with GAIN.

While fortification of selected foods may be useful in some cases, GAIN’s interventions with governments are worrying. The philanthropic packaging of the GAIN message and the image transfer from GAIN’s UN partners, can be used to push processed, ready-to-eat foods into national public health nutrition systems, so undermining breastfeeding and the use of indigenous, traditional and low-cost foods, and exacerbating problems for those most in need.

Mark Ameringen, the Executive Director of GAIN, explains how we are all expected to work together to help companies establish these new markets:

REF: Opportunities and challenges for the food industry in reaching the poor. M.Ameringen, B. Magarinos (Sen. Man. GAIN) M.Jarvis (World Bank), Business & Malnutrition: Development Outreach June 2008.

• A silent protest by public health experts and NGOs took place in Dehli in April, calling on GAIN to leave India. The ongoing controversy over whether traditional cooked meals should be replaced with packaged food at Integrated Child Development Services centres, has alerted people to the risks of nutrition interventions which ignore conflicts of interest and the need for an independently-funded evidence base and independent monitoring of the outcome.

The UK and WHO

The UK funds 11% of WHO’s budget and is now the second largest contributor after the USA’s 16%. (The USA used to contribute 25%.) However, it is not clear how much of this money is going to WHO and how much to PPPs.

Responding to the UK Government’s consultation on its new ‘Institutional Strategy’ for relations with WHO, the National Heart Forum and the International Association for the Study of Obesity (IASO) highlighted conflcts of interest.

IASO said :

IBFAN and NGOs have written to EASO (the European member) about the sponsorship of the European Congress on Obesity in Geneva by Nestlé and Unilever, in conflict with EASO’s own guidelines!

• See www.ibfan.org for papers on PPPs, including the UNRISD paper, Beyond Pragmatism: Appraising UN-Business Partnerships.

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Watching EU

EFSA: tough on claims?

The EU Nutrition and Health Claims Regulations (1924/2006) was amended at the last minute following the concerns of Parliamentarians about claims on foods for children. All children’s health claims, disease risk reduction claims and claims based on new evidence (Article 14 claims) must now be evaluated by the European Food Safety Authority (EFSA). This means that under EU law no claims should be made on follow-on milks or baby foods unless they are cleared, or are awaiting clearance, by EFSA. (Claims can be made on infant formulae if they are listed in the Infant Formula Directive (141/2006/EC, Annex 1V).

Companies have submitted applications for over 2,800 claims including over 200 Article 14 claims. These include a Nestlé claim that Bifidobacterium lactis in formula and milk-based products “strengthens natural defences” and a Ferrero claim that “Kinder Chocolate is the chocolate that helps you grow.” The can of worms is well and truly open.

Baby Milk Action, on behalf of IBFAN, the BFLG and the BMC, sent submissions calling for all health and nutrition claims on foods for infants and young children to be rejected on the grounds that they mislead the public and undermine breastfeeding and sound complementary feeding.

EFSA rejected the majority of the first applications, including a MARTEK claim for follow-on milk: “DHA and ARA support neural development of the brain and eyes.” EFSA said MARTEK failed to demonstrate causality between consumption of DHA/ARA and a benefit to infants between 6 months to 3 years. The food industry, which already proclaims the excellence of its products, expressed fears worried EFSA was setting too high a standard. We breathed a sigh of relief and saw this as a signal that EFSA was prepared to put scientific substantiation before commercial interest.

EFSA did, however, give an ambiguous opinion on UNILEVER’s alinolenic acid (ALA) claim about growth and development of children and has followed this with a positive opinion for French Dairy Industry (ATLA) claims on Vitamin D, Calcium and bone health.

There is a 30-day public consultation period following the publication of each EFSA decision, and the Commission and Member States will decide if and how these claims can be used. We will need to keep a close eye on developments.

• Baby Milk Action has worked for years with Glenys Kinnock MEP to increase the transparency of EU scientific bodies because of our concern about the undue corporate influence on EU policy making. The rules adopted in 2000 require members to declare their financial links to industry. EU advisory committee members declare their interests BMJ 2000;320:826 ( 25 March )

• A major problem with the Infant Formula and Follow-on Formulae Directive is that it allows ingredients to be added on an optional basis. This is an illogical and risky notion for products which play such a critical role in child development. Ingredients should only be added which have been proven to be safe and essential and the evidence for this should include a good proportion of independently-funded research (something that is not an EFSA requirement). As things stand, companies are adding unchecked, novel ingredients, one by one, alongside a range of unauthorised claims - and leading parents to believe that they must choose at point-of-sale between very different health outcomes.

• Although the proportion of long-chain fatty acids in breastmilk is clearly important the efficacy and safety of the artificially-made versions are questionable. 

Public Private Partnerships - companies and education

“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

Jean Giraudoux (1882-1944).

Baby Milk Action represents IBFAN on the European Commission’s Platform on Diet, Physical Activity and Health which brings companies, such as Mars, Nestlé, Pepsi and McDonalds together with public health NGOs supposedly to find strategies to combat obesity and food-related ill-health.

There have been several Platform meetings focussing on nutrition education and publicprivate-partnerships (PPPs). The NGOs are concerned about the predominance of industryfunded education schemes, despite the lack of evidence that information campaigns alone can deliver behavour change. Nestlé has many schemes advising parents.

At the meeting in July, EU Commission Chair and Dir. General of DG SANCO, Robert Madelin, asked why companies fund education. The CIAA representative, working for Mars, responded saying that it is to “help the whole population to understand, appreciate and enjoy their products, but not in excess.....” The minutes of this meeting for the first time suggest that “economic operators could avoid education and focus more on their core expertise: reformulation and marketing” and that the term: ‘partnership’ could be re-named as ‘coalitions of interest.’

At two meetings with Member States in October we continued to press for the risks of PPPs and commercial involvement in schools and education to be acknowledged and to warn of the undue pressure on policy setting. Robert Madelin had, in the July meeting, said that to his knowledge such pressure had not occurred at Commission level, but that he was aware that it does at Member State level and that the Commission had been asked to help. Meanwhile chocolate and baby food sales rise.

REF: Edinburgh Evening News. Business.com, 4 July 2008
Mintel, Baby Food, Drinks and Milk, Market Intelligence, Nov. 2007

• The European Ombudsman took up our complaint of ‘maladministration’ by the EU Commission and asked the President of the Commission to respond to the allegations that it has failed to protect public health and has ignored Member States’ obligations to implement the International Code.The Ombudsman will make a decision in 2009. (See website link.)

• Our comments to the Department for Children, Families and Schools (DCFS) consultation: Assessing the Impact of the Commercial World on Children’s Wellbeing contain a critique of several industry-funded education schemes such as MediaSmart and Nestlé’s Phunky Foods. The National Heart Forum noted that the review of Media Smart was conducted by Prof David Buckingham (who was involved in its development) and paid for by Media Smart and the Advertising Association itself! We will rework our education Pack, Seeing Through the Spin and welcome reports of industry-funded education materials. 

• We are members of ALTER-EU (the Alliance for Lobbying Transparency and Ethics Regulation), a coalition concerned with corporate lobbying of EU policy making. www.alter-eu.org

• Danone sponsored a Fringe meeting on Obesity and Toddlers at the Labour Party Conference in September. David Algar of Nutricia claimed that adult food is inappropriate for babies and went on to promote PPPs and the Nutricia-sponsored education project, MEND. Much to his annoyance, we highlighted the company’s Code violations. The Fringe meeting scheduled for the Conservative Party the next week was mysteriously cancelled.

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Melamine contamination deaths in China show need for regulations

The scandal of Melamine contamination of formula and other dairy products in China which created global news in August has been a frightening wakeup call for all parents who have been persuaded to place their trust in brands. 54,000 babies have been hospitalised in China with problems including kidney stones and at least four have died as we go to press. (Chinese parents speak out on TV: http://tvnz.co.nz/view/page/899522/2203262)

The worst-affected company, Sanlu (in which New Zealand Fonterra has a 43% holding), blamed farmers for adding the chemical to milk. It now seems that there were many reports of sick babies from the beginning of 2008, but nothing was done until after the Olympics. Shocking as this is, its clear that lack of proper scrutiny and regulation is not confined to China, nor to Chinese companies. Melamine contaminated formula has now been found in more than 22 brands and many products have been removed from shelves in many countries. Babies have become sick from this contamination in Taiwan, South Korea and elsewhere.

Tragic as the Sanlu issue is for the families concerned (including, perhaps, the recipients of Sanlu’s much publicised $1.25 million donation of formula to the Sichuan earthquake in May) it’s important to put this into perspective. With a population of 1.3 billion and 17 million births each year, China has falling rates of breastfeeding.1 It has good literacy levels, good health infrastructure and lower maternal and infant mortality rates than in many developing countries, but about 300,000 children under 5 still die each year from diarrhoea and respiratory illness.2 A large number of these deaths (perhaps one third or more) are due to poor infant feeding practices, including bottle feeding, which undermine the health gains made. Bottle feeding deprives infants of breastmilk and actively harms the child’s immune system, exposing it to sources of infection. The deaths, and the additional burden of serious non-fatal illness in bottle-fed babies, are the result of the use of formulas supposedly developed to the highest standard - a standard that is seriously deficient. These deaths and illnesses are presumably considered to be ‘acceptable’ and so go unnoticed.

China’s 1995 regulations on the International Code are incomplete and not fully implemented, so companies ignore them, or use the loopholes they lobbied for, to aggressively fight for chunks of the vast Asian baby food market. Action on the Code is urgently needed to alert Chinese parents to the risks of artficial feeding, provide them with breastfeeding and relactation support. But it must also stop all the follow-on milk promotion and the claims that formulas make their babies cleverer and healthier.

What is Melamine? 

Melamine resin, a mix of melamine and formaldehyde (used in the manufacture of formica and floor tiles) is rich in nitrogen, and relatively cheap. When added to sub-standard or watered-down milk the protein level appears higher, enabling farmers to meet quality specifications. 

Also implicated is the contaminant, cyanuric acid: “Melamine alone is of low toxicity, however experimental studies have shown that combination with cyanuric acid leads to crystal formation and subsequent kidney toxicity.” A WHO Briefing stated: 

The Sanlu product incriminated in the cases in China was contaminated at a level of over 2500 mg/kg powder, corresponding to approximately 350 ppm in reconstituted product (assuming a 7-fold reconstitution factor)... Considering a 5kg infant, the tolerable amount of melamine would be 2.5 mg per day. This amount would be reached when consuming 750 ml liquid (or reconstituted) formula contaminated at a level around 3.3 mg/l (ppm).

The melamine level in the reconstituted formula is over 100 times this amount.

Other contaminants

Update readers will know that melamine is not the only contaminant artificially fed infants have to cope with. Contamination with Enterobacter Sakazakii which can also cause infant fatalities, is worryingly common (found in 14% of tins in a study cited by the US Food and Drug Administration). Yet companies still refuse to warn parents that powdered formula is not sterile or inform them of the simple steps required to kill possible bacterial contamination (see China story and our survey of UK company telephone 'carelines' in Update 40). 

In August, the Austrian Agency for Health and Food Safety ordered the recall of Enterobacter Sakazakii contaminated formulae: HIPP Hypoallergene Anfangsnahrung HA1 (Starter Formula HA1), Milupa Pre Aptamil HA, Wyeth Babylove Dauermilch. See also concerns about Bisphenol A, the contaminant in plastic baby bottles and formula tins. Details of recalls are posted by IBFAN’s working group on contaminants.

See also Risks of Formula Feeding, by Infact Canada in our online shop.

IBFAN’s International Code Documentation Centre (ICDC) in Penang, Malaysia is compiling reports on the widespread violations of the Code in China and South East Asia, including Sanlu’s advertising on buses.
ICDC’s report, Cashing in on the China tainted milk scandal, shows how companies are taking out expensive ads in major dailies and public places to reassure parents in Hong Kong, Singapore and Malysia that their products are safe.

Nestlé’s role - a safe alternative? 

In September, speaking in India as the melamine crisis was growing, Nestlé’s Chairman, Peter Brabeck-Letmathé, gloated that his company was actually benefiting from the crisis, saying: “All our products are 100 percent safe... Sales in China are rather being favoured... It’s rather positive than negative.” (See: Nestlé sees positive impact from China milk scandal - Reuters 26.8.08) 

A misleading press release (21.10.08) stated: “the Chinese authorities have issued official certificates for all tested Nestlé products stating that no melamine has been detected in any of them” and referred to a report from the Hong Kong Government’s Food and Environmental Health Department, but did not link to it. Our new Nestlé Critics website did link to the report, noting that Nestlé Dairy Farm UHT Pure Milk was on the contaminated list with 1.4 ppm (above government safety limits). 

Taiwan later found contimation in a range of processed foods and called for delisting of the products, taking a zero tolerance approach. Another Nestlé press release (2.10.08) said it “fails to understand temporary delisting request.” However, it agreed to the recall. It also withdrew products in South Korea. 

In 2005 Nestlé blamed excessive iodine levels in its formula on milk suppliers and at first refused to recall products, prompting a consumer boycott and the comment in the China Daily (10.06.05): “Nestle was caught remarkably flat-footed for a multinational firm of its global standing. Many believe it reacted with the speed and alacrity of a sailor drunk on shore leave.”

A little bit of history 

Nestlé opened the first baby milk factory in China 1990 and another in 1995. In 1996 Save the Children (SCF) exposed how Nestlé’s pushing of free milk into Chinese hospitals was undermining breastfeeding in the Yunnan Province. (Update 19 Boycott News, Financial Times (8.7.96), New Internationalist No 275). 

SCF maintained private correspondence with Nestlé for a year before going public with their concerns. Nestle refused to accept responsibility for its actions and described SCF’s campaign as a “barren pursuit.”

A bus on one of the busiest routes in Beijing serves as a mobile ad for Sanlu: “the best selling infant formula for 12 years”

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Evenflow progress

ICDC’s September Legal Update reports the encouraging story of the US company, Evenflow’s efforts to become ‘Code compliant.” The feeding bottle promotion has been removed from its website and the breastpump and bottle packaging redesigned. The ‘Best for Baby’ slogan has been changed to ‘Breastfeeding Best for Baby.’ Although further changes are needed - it’s a good start.

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Breastfeeding reduces infant deaths in India

Infant mortality in Chhattisgarh has dropped from 84 to 59 deaths for every 1,000 children in the last eight years. The drop is directly linked to a dramatic rise in the number of women exclusively breastfeeding their children for the first six months. This figure has risen from 35% in 2002 to 82% as a result of an initiative by UNICEF, CARE and the Chhattisgarh Government. (15.8.08 Hindustani Times)

• IBFAN’s Breastfeeding Promotion Network of India (BPNI) is doing a huge amount of work to protect breastfeeding, while still attending the ongoing trial of Nestlé- now in the 14th year - for failure to label its infant formula and cereals in compliance with Indian law. www.bpni.org

• New report: Awareness and reported violations of the WHO International Code and Pakistan’s national breastfeeding legislation, by Mirhetab Salasibew et al. (17.10.8)

www.internationalbreastfeedingjournal.com/content/3/1/24

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Bisphenol A: new danger

Canada is the first country to announce a ban on the import, sale and advertising of baby bottles containing Bisphenol A (BPA) declaring it a toxic substance that is hazardous to human health. BPA is a chemical used in many plastic products including some baby bottles. It is also in the lining of some formula cans. BPA has been linked to obesity, infertility, edocrine disruption, early-onset puberty and prostate and breast cancer.

Meanwhile, the U.S.Food and Drug Administration (FDA) has been criticized for continuing to deem BPA safe and for relying on two industry-funded studies while ignoring many dozens of independent research findings.

A Washington Post article (13.10.08) cities a US$ 5 million donation by Charles Gelman to the University of Michigan’s Risk Science Center. Gelman is the retired head of a medical device company and a known BPA supporter. The Center’s acting head, Martin Philbert, is head of the FDA advisory panel delivering the BPA risk assessment, but did not report the gift to the FDA when he was appointed. He maintains that this was because he does not stand to gain from the funds. The FDA is looking into a possible conflict of interest. The EU Food Safety Authority (EFSA) considers that BPA is not a hazard. 

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Kennedy 30 years ago...