Social Participation in Health, known also as Community Action for Health or Community Participation in Health has a long and storied history. As global consensus grows on the centrality of this driver of health reform, we undertook to document lessons, with a focus on India’s national process as well as the experiences of the southern Indian state of Kerala. This is just a snapshot of the many experiences in the subcontinent with social participation and community action and we have aimed to use the novel method of Witness Seminars to carefully archive these histories from the perspective of its shapers – it’s witnesses. This resource is a intended for use by citizens, advocates, researchers and implementers to learn and act in to bring about societal change in the service of health.

Learn more about the method adopted to carry out this work at the national level here, and in Kerala, here.

The George Institute for Global Health draws on our latest evidence to produce statements, recommendations, and reports to inform policy, guidelines, and practices across the world. We engage with key decision makers to enact real change in health policy and practice where it is needed most.

On request, The George Institute for Global Health prepared this report for Te Whatu Ora Health New Zealand to contribute to their rapid review of data on New Zealanders’ attitudes to alcohol policy interventions. This involved secondary analyses of international data on public support for 14 alcohol control policies, focusing on the New Zealand-specific information from the larger data set.

This report examines New Zealanders’ support for policies relating to the provision of alcohol-related information to consumers, restricting alcohol advertising and sponsorship, and implementing a government harm-reduction taskforce. Examples include ‘Alcohol products should have health warning labels on the package’ and ‘Alcohol sponsorships should be removed from elite/professional sport’.

Overall, most New Zealanders supported many of the assessed alcohol control policies. Females, older adults, those with a lower household income, and those who abstain from drinking were more likely to indicate support.

The report provides Te Whatu Ora Health New Zealand with important information regarding support for alcohol control policies in New Zealand and demographic differences in levels of support for these policies.

The George Institute for Global Health is pleased to contribute to the public consultation on the Horizon Scan to Support Strategic Planning for the Australia New Zealand Food Regulatory System for 2023-2026.

The George Institute commends the inclusion of matters of significant concern to public health within the Horizon Scan. We further wish to note our support for the approach the Horizon Scan takes, which recognises the interplay of global mega trends on health outcomes.

We do, however, join our public health and consumer colleagues in raising a number of key concerns regarding the Horizon Scan, both in terms of substance of the document and how it sits within the broader strategic planning and regulatory reform context. Most notably:

• The processes and intended outcomes of both this specific consultation and broader strategic planning work have not been made clear to all stakeholders, through either direct communications or through the material provided and the Stakeholder Forum.
• How this consultation and its outcomes relate to other reform work currently underway, such as the Food Standards Australia and New Zealand (FSANZ) Act Review and the development of Aspirations for Australia and New Zealand’s Food Regulatory System.
• The Horizon Scan does not adequately prioritise the significant and increasing burden of diet-related chronic disease in Australia and the root cause of this, being the proliferation of unhealthy food environments.
• The Horizon Scan does not recognise the role of our food regulatory system in facilitating these trends to date and its great potential to arrest them.

The George Institute welcomes the opportunity to further engage with the Food Regulation Secretariat, Food Regulation Standing Committee and Food Ministers on priorities for the food regulatory system and related issues outlined in our submission. We also would welcome the opportunity to provide further evidence to support our submission on this page.

The George Institute for Global Health is pleased to contribute to the public consultation on the World Health Organization (WHO) draft guideline on policies to protect children from the harmful impact of food marketing.

Across the globe, marketing of unhealthy products to children is a powerful tool used by food manufacturers to increase unhealthy food consumption, alter preferences, stimulate purchase requests, and ultimately adversely impact human health. Marketing limits the uptake of healthy and sustainable diets and is associated with increased rates of diet-related non-communicable diseases (NCDs), including overweight and obesity, dental caries, diabetes, and some cancers. Based on this work and the broader evidence base, we strongly recommend that the marketing of unhealthy products to children is restricted to ensure the healthiest start in life, particularly among communities experiencing greatest vulnerability.

In our response, we share recommendations to improve the overall clarity and support implementation of the Guideline. Moreover, we highlight missing data and context and setting specific issues that have not yet been captured.

This submission was prepared by members of the Food Policy and Impact and Engagement Team, in addition to a complementary, joint submission that was co-developed with the NCD Alliance, NCD Child, World Cancer Research Fund International and the World Obesity Federation.

We congratulate the WHO on the development of the Guideline and stand ready to collaborate to address research gaps and considerations identified by the WHO.

Front-of-pack labels (FoPLs) are an important tool to support consumers in making healthier food choices. A FoPL’s purpose is to inform consumers about the relative healthiness of products and indicate excessive energy, added sugars, saturated fats, and/or salt, which are associated with risk for non-communicable diseases (NCDs) including heart diseases, high blood pressure, diabetes mellitus, and obesity.

Many pre-packaged foods available in the market are processed with elevated levels of added sugars, salt, and/ or saturated fats, which are associated with increased risk of many diseases. We urgently need to adopt a front-of-pack labelling policy to help consumers make healthier food choices and reduce the country’s overall NCD burden. In this context, WHO India in partnership with The George Institute for Global Health undertook a study to assess the effectiveness of front of pack labels for processed food products.

Based on the findings of the study, a policy brief was developed to provide recommendations for the implementation of an effective FoPL as part of a comprehensive strategy to promote healthier diets. The implementation of front-of-pack labelling, supported by a robust campaign to enhance nutrition literacy in the population, can contribute significantly to the prevention and management of NCDs through positively influencing the dietary habits of consumers and assisting them in making healthier food choices.

The George Institute appreciated the opportunity to provide feedback on the updated Appendix 3 of WHO’s Global action plan for the prevention and control of noncommunicable diseases (NCDs) 2013–2030 and commends WHO for its efforts to revise it in light of advancing scientific knowledge.

The George Institute for Global Health contributed two submissions to the call:

• The first was developed with researchers across The George Institute in response to the first web-based consultation;
• The second was a joint submission with the NCD Alliance, and members of its network.

We strongly support the overall approach and the intention to assist countries selecting a combination of these interventions to define locally tailored packages of interventions to accelerate ongoing national NCD responses. The George Institute, however, believes there are several ways Appendix 3 could be improved to achieve NCD Targets by 2025, as well as facilitate the realisation of Sustainable Development Goals (SDG) Target 3.4.

To ensure its objectives and ambitions are realised, we have made several comments and reflections as summarised below:

• Appendix 3 should highlight the importance of equity considerations, and the need to consider the impacts of interventions on communities experiencing marginalisation because of historic power imbalances.
• A sex and gender lens should be applied to the updated Appendix 3, reflecting the latest scientific evidence on the differential impact of NCD risk factors for women and men.
• Appendix 3 would be strengthened with further guidance on how to combine packages of interventions where there are synergies in cost and outcomes.
• It is important to name Appendix 3 and retain the concept of NCD ‘best buys’.
• More information on the methodology of this update, the use of healthy-life year (HLY) unit, how cost-effectiveness was measured for interventions that include several components, and clarification on methodological limitations.
• Appendix 3 should be more consistent across sections, especially in detailing the overarching/enabling actions and outlining non-financial considerations across risk factor sections.
• Appendix 3 should be as clear and precise as possible with the description of interventions.
• The consultation and updating processes need to be strengthened.
• Appendix 3 needs to reflect the evolving NCD agenda.

The George Institute for Global Health has contributed a submission to the New South Wales Parliament’s Legislative Assembly Committee on Environment and Planning Inquiry into Food Production and Supply in NSW.

“We commend the committee on its willingness to investigate the impact climate change and COVID-19 are having on food systems and food security in New South Wales. However, we need to talk about the nutritional quality of food, not just the volume of food that is produced and available,” said Damian Maganja, Research Associate and PhD Candidate in the Food Policy Division at The George Institute for Global Health.

“When we consider changes to the food system, it is important to recognise that a person can be in a state of food insecurity but not necessarily hungry,” said Maganja. “While hunger is still a major problem in NSW, many people are also struggling to access healthy foods and follow healthy dietary patterns amidst systems and environments that prioritise unhealthy products. The healthiness of the foods produced, made available and consumed, must be considered throughout this Inquiry”.

The George Institute’s submission also conveys the urgent need to collaborate with First Nations peoples to address issues of food security, production and supply in a way that integrates First Nations peoples’ lived experiences of food and water systems and ensures better health.

“First Nations Elders and local Aboriginal Community Controlled Organisations are best placed to lead the development of culturally appropriate, sustainable solutions that empower and strengthen their communities,” said Dr Julieann Coombes, Co-Lead of the Aboriginal and Torres Strait Islander Health Program at The George Institute.

“The gradual damage to strong connection between First Nations peoples and Country - where Country includes the complex food and water systems that embody the social, emotional, cultural, spiritual and physical aspects of First Nations Health and well-being - has had enormous impact on the nutrition, health and well-being of remote communities.”

“An equitable food system means genuine engagement with First Nations communities, and we call upon the NSW Government to act,” she added.

Added sugar labelling in Australia and New Zealand

Foods and drinks can contain both ‘naturally occurring’ and ‘added’ sugars. Excess consumption of added sugars is associated with dental caries, poor dietary quality and excess weight gain. Excess weight gain can increase a person’s risk of developing chronic diseases such as heart disease, type 2 diabetes, chronic kidney disease and many cancers. These illnesses reduce quality of life and cut thousands of Australian and New Zealand lives short each year.

Australians and New Zealanders currently eat too much added sugar with more than one in two exceeding the World Health Organization maximum recommended limit for intake of sugars. In Australia, sugar intakes are highest for the most socio-economically disadvantaged households, a group that experiences the greatest diet-related disease burden.

What is added sugar?

Existing Australian Dietary Guidelines recommend avoiding added sugars, whereas more recent World Health Organization guidance recommends limiting consumption of ‘free’ sugars, which includes not just added sugars but also sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. Foods high in added or free sugars may displace more nutritious foods in the diet and contribute to dental caries, unhealthy weight gain, and non-communicable diseases. Currently, manufacturers in Australia and New Zealand are required to provide only ‘total sugars’ information in the mandatory nutrition information panel, meaning consumers have no easy way to identify the added or free sugars they should be avoiding.

The George Institute for Global Health joins public health and consumer groups in supporting improvements to the labelling of sugars of packaged food and drinks in support of dietary guidelines and for better health outcomes.

How can consumers cut sugar intake?

There are a number of steps that consumers can take to reduce their intake of added sugars. They include:

• Look out for added sugars on the ingredients list. There are more than 800 terms, but common ones include fructose, rice syrup, dextrose, maple syrup, glucose, sucrose and all types of sugar (brown, white, raw).
• If a product contains more than 15 grams of sugar per 100 grams, it probably contains added sugar. Look for those that have under five grams per 100 grams instead.
• Cut back on foods that are high in added sugar, such as confectionery, ice-cream, sugary drinks, flavoured milk, biscuits and cakes.
• When choosing between products, opt for plain and unsweetened varieties e.g. natural yoghurt, plain milk and unflavoured meats.
• Spend more around the perimeter of the supermarket where you’ll find healthy staples including fruit, vegetables, milk, eggs, nuts, meat and bread. These foods should make up the majority of your diet.

Download the FoodSwitch app. It will tell you how much added sugar is in a product and recommend healthier alternatives to switch to.

Policy action on added sugar

Consumers have a right to know what is in the foods they choose to buy. Through added sugars labelling reform, the government can ensure that food manufacturers accurately inform consumers about added sugars in packaged foods, enabling consumers to identify and limit added sugars as advised by the dietary guidelines. Beyond informing consumers, added sugar labelling could also stimulate food manufacturers to cut the sugars they add to products, or develop new products with less added sugars. Provided manufacturers do not simply substitute added sugars with other unhealthy ingredients, such as non-nutritive sweeteners, added sugar labelling could stimulate reformulation to create a heathier food supply and reduce the number of high added sugar products available for sale. This means that all consumers could eat better, regardless of where they shop or how much they understand information on labels.

In 2017, the Australian and New Zealand Ministerial Forum on Food Regulation (now the Food Ministers’ Meeting) began looking at sugar labelling and regulatory options for improving information provided by manufacturers on labels. In August 2019, the Forum requested Food Standards Australia New Zealand (FSANZ) to review nutrition labelling for added sugars. At that time, the Forum noted that the option to quantify added sugars in the Nutrition Information Panel (NIP) best met the objective of providing adequate contextual information to enable consumers to make informed choices consistent with dietary guidelines recommendations. Forum Ministers also noted that an option for pictorial display (e.g. teaspoons) applied to sugary drinks warranted further consideration, along with other options. FSANZ is currently reviewing whether and how the Food Standards Code should be amended, including technical issues such as how ‘added sugars’ should be defined in any regulatory updates. To ensure that food labels accurately inform consumers about added sugar content levels and enable consumers to identify healthier options, reforms must:

• include mandatory quantification of added sugars in the nutrition information panel (NIP);
• incorporate a comprehensive definition of added sugars that includes all types of added sugars and minimises risk of potential loopholes;
• be implemented without delay; and,
• be supported by a complementary suite of measures to promote healthier diets.

Please refer to The George Institute's ‘Supporting evidence-informed policy work on added sugar’ Report on this page commissioned by VicHealth to investigate what food components should be included in a definition of ‘added sugars’ if regulatory reforms were to proceed.