Reach for the health stars

Outcomes of the five year review of the Health Star Rating (HSR) take Australia and New Zealand’s nutrition labels a step closer to being world-leading, according to an analysis of front-of-pack labelling published in BMJ Global Health.

But there are lessons to be learned from other countries that could make our national system more effective, according to public health lawyer and Research Fellow at The George Institute, Alexandra Jones.

“Unhealthy diets are a leading cause of death and disability in Australia and around the world, fuelled by the unprecedented availability, accessibility and affordability of processed and pre-packaged foods.

“Governments are responding by implementing stronger food labelling to encourage healthier food choices and promote food reformulation by industry, but they need to keep pace with the evidence to address the growing health burden,” she said.

“In Australia it’s encouraging to see that Food Ministers have adopted a number of recommendations from leading consumer groups in the recent HSR review, such as removal of the energy icon. This is a big win for consumers as it was being used mainly on low scoring confectionery and soft drinks in lieu of providing the true rating of these junk foods.”

“But in other areas we are still lagging behind – ten countries now have mandatory labels, eight of these have been adopted in the last five years. There’s no reason, other than obvious food industry opposition, why the HSR couldn’t also be mandatory,” Ms Jones added.

Simple, graphical front-of-pack (FOP) nutrition labels are part of the package of policies recommended by the World Health Organization to address diet-related conditions such as obesity, heart disease, type 2 diabetes and some cancers. More than 30 countries have now adopted some form of FOP nutrition label and the evidence about what ‘works best’ to improve diets is rapidly evolving.

“There’s been a global shift towards labels that show product unhealthiness. These include ‘stop signs’ to indicate products high in salt, sugar and fat that are now being used in Chile, Peru, Uruguay and Israel, traffic light options in the UK and Ecuador, the Nutri-Score in France, Spain and Belgium which ranks foods from A-E, as well as Australasia’s Health Stars,” said Ms Jones.

“These types of signals appear to be more effective in guiding consumers towards better food choices. Health Stars have that potential, but in their voluntary form, they’re being used mostly on products that score well. This means in practice they’re acting as a weaker positive ‘tick’ on foods. This is not good enough – it’s time consumers received the benefit of the full range of star ratings.”

In Australia and New Zealand, government reports suggest shoppers understand and like the Health Stars logo, but international practice suggests ways it could be improved. One way would involve creating additional rules about the way Health Stars are displayed, which could include instructions on the use of colour.

“Health Stars are the only labelling system where manufacturers can use any colour, making it harder for consumers to spot,” Ms Jones added.

“If we wanted to go further, we could follow the lead of countries like France who suggest specific placement of the logo on pack e.g. top right, to make it even easier to see quickly – these rules could be implemented through updates to the Health Stars style guide,” she said.

International best-practice in this area of health policy also requires governments to make sure labelling policies are governed in a manner that protects them from being weakened or undermined by the food industry.

“Looking at how FOP nutrition labelling policies are developed and implemented around the world, we can see that the HSR is one of only a handful of labelling systems worldwide where industry were involved as collaborators on committees determining how ratings are calculated,” added Ms Jones.

“This aspect of Health Stars has weakened consumer trust, so it’s great to see the Five Year Review looking at this and moving towards international best-practice which recognises that government and independent experts are best placed to set the terms of health policy.”

While the conclusions of the Five Year Review suggest Health Stars will remain voluntary for now, Ms Jones cautiously welcomed the Ministers’ commitment to working on targets and an implementation plan.

“It is critical that this plan provides a genuine threat that Health Stars will be made mandatory if sufficient progress is not achieved,” she said.

“As the epidemic of diet-related diseases accelerates, we need to get tougher on food labelling to have any chance of stopping some of Australia’s biggest killers.”