More bumps ahead for industry in Singapore's war on diabetes as hawkers let off the hook

The ‘Drink Water’ campaign, first mooted by a Citizen’s Jury as part of the nation’s War on Diabetes has now been backed by Singapore’s Ministry of Health (MOH), which has voiced its support for 14 out of 28 recommendations.

Dr Amy Khor, Senior Minister of State for Health, said the MOH set up the first Citizens’ Jury “to raise awareness about diabetes efforts; and generate community-based recommendations on how to better prevent and manage diabetes as a nation”​.

The 76 members of the Jury from all walks of life were selected in an independent process by the Institute of Policy Studies. Of these, 34% are living with diabetes, 17% are healthcare professionals (endocrinologists, podiatrists, nurses, physiotherapists, and so on), and the rest were caregivers and persons without any experience with the disease.

Industry impact​

The MOH strongly supports the water recommendation and agrees that “plain water is indeed a healthy option”​ and that it “encourages more of such ground-up efforts”​.

“Citizens can tap on government grants for ground-up initiatives, tap into their personal networks, and leverage social media to spread the message of drinking more plain water,”​ said the MOH.

The Jury also made other recommendations, such as that advertisements on fast food and snacks that are targeted at children be curtailed, while advertisements on healthy food and physical activity be increased.

It also recommended that the use of garnish in food advertisements and menus be limited.

“We agree that children should not be targeted by unhealthy advertising. There are existing guidelines under the Advertising Standards Authority of Singapore (ASAS) which stipulate that all food and beverage products promoted in marketing communications targeted at children aged 12 and below must meet a set of nutrition criteria,” ​said the MOH.

“For example, all sugar and sugar-based products, carbonated and non-carbonated soft drinks including diet drinks should not be advertised to children below 12.”​

It stated that the Health Promotion Board (HPB) will work with researchers and other partners to analyse the content of advertisements targeted at children since the introduction of the Food Advertising guidelines to children, and explore how to improve compliance to the guidelines.

Perhaps more controversially, on the promotion of nutritionally-poor food or its on-shelf placement, the jury recommended placing such food at harder to reach places to reduce access and, hence, consumption of these foods.

“We acknowledge that product placement plays an important role in influencing our decision to eat healthily. Product placement is often a negotiated and contractual agreement between importers/distributors and supermarkets,”​ the MOH said in response.

“During campaign periods, HPB encourages consumers to choose healthier products bearing the Healthier Choice Symbol through nudges such as wobblers and advertisements placed at strategic spots in the supermarkets.”​

Nonetheless, the MOH said these are among the recommendations it will further explore before deciding or committing to support.

Other recommendations — which MOH has given support — included re-examining the “Healthy Meals in Schools” programme, popularising “My Healthy Plate” guidelines and visual aid for a daily balanced diet, and healthy food preparation and cooking competitions, as well as expanding cooperation with organisations offering cooking courses to teach people how to cook simpler, healthier meals.

Hawkers given a bye?​

The only recommendation the MOH said it is definitely unable to support at present is that hawker stalls and centres be rated on nutrition.

“Rating hawker centres may be challenging because there are many hawker stalls selling both healthy and unhealthy dishes in their stalls,” ​said the MOH.

“HPB has an ongoing programme to engage hawker and other food vendors to provide healthier food options that are 500 calories or less. As part of this effort, hawker stalls selling the ‘healthier’ option have been marked with a decal for the healthier options and HPB educates the public to choose the healthier dishes.”​

The MOH said the response from the hawkers to this has been encouraging so far and HPB has plans to expand the number of healthier options available in hawker centres.

Food and beverage manufacturers have so far borne the brunt of Singapore’s War on Diabetes, while hawker stalls and centres have not been affected to such an extent.

Trade body Food Industry Asia (FIA) said it supports the view that a sustainable and multi-stakeholder effort is needed to improve diets and stabilise rates of obesity and diabetes.

It pointed to the fact that seven leading beverage companies pledged last year to reduce the sugar content in their drinks by 2020.

“Such partnerships are key in the battle against diabetes,”​ said Steven Bartholomeusz, policy director of FIA.

He added, referring to the Food Advertising guidelines mentioned by MOH, that the pledge on regulating advertising and marketing to children was voluntarily taken by 14 leading international companies. He said this was developed by a multi-sector consortium comprising stakeholders from the government, the food industry, media companies and consumer groups.

However, he expressed some concern about the recent recommendations.

“Obesity and associated non-communicable diseases (NCDs) like diabetes are complex, multi-factorial issues,”​ said Bartholomeusz.

“Policy actions and interventions aimed at influencing the behaviour and habits of the population, such as nutrition education and improving diet, lifestyles and obesogenic environment, should look at positive incentives to empower people to make better dietary and lifestyle choices.​

“I would think that any scheme that tackles diabetes would need the full support of manufacturers, retailers and restaurants working in partnership with the government, and such a scheme needs to be non-discriminatory.”​

Beverage firms have also been impacted by a series of sugar taxes across the region, a move that the Singapore government has so far declined to take.