It’s billed as a simple recipe for better health, but how effective is government’s Health Star Ratings system for packaged foods as it undergoes five-year implementation review?
Public Health Association of Australia chief Michael Moore takes us behind the scenes of a recent forum on the voluntary labelling campaign introduced in 2014, involving the academic, government, health, consumer and industry sectors.
Michael Moore writes:
The Health Star Rating System (HSR) came under intense scrutiny at a forum facilitated by the Public Health Association of Australia (PHAA) with the support of the Health Star Rating section of the Department of Health.
The PHAA challenged attendees to consider the workings of the algorithm in detail, and to reflect on how well it relates to the Australian Dietary Guidelines and the Guide to Healthy Eating.
There was lively debate as over fifty attendees drawn from public health, government, academics, consumers and industry engaged in discussion on how to improve the system. The PHAA has been a long-term advocate for better food labelling as part of a comprehensive national nutrition policy, and the HSR is a key component of this.
The forum took place during the period of the five year review of the system, and the consultants conducting this review for government were in attendance, providing an opportunity for speakers and attendees to influence changes that they consider appropriate. The facilitator of the forum was Professor Heather Yeatman from Wollongong University who has been appointed by food ministers as a member of the Health Star Rating Advisory Committee.
A complex calculation
Dr Greg Gambrill, from from the HSR’s Technical Advisory Group, provided a detailed understanding of the workings of the algorithm and dispelled some of the myths around inclusion of nutrients such as protein.
The inclusion of protein in the algorithm was queried, as there is no shortage of this macronutrient in the Australian diet. One consideration suggested by Dr Gambrill is that protein is also an indicator for other nutrients. There are significant challenges in removing or adding individual nutrients because of unforeseen outcomes.
The approach taken by HSRAC and its Technical Advisory Committee is to check any proposed modification against the databases of foods that are available. Dr Gambrill noted that industry has been forthcoming with details of new foods.
Professor Bruce Neal from the George Institute presented evidence on the success of the HSR – although he identified some areas where the ratings appeared inappropriate against the Dietary Guidelines and the Guide to Healthy Eating and modifications were required.
Deakin University’s Professor Mark Lawrence argued that basing the system on nutrients rather than whole foods meant that it would never completely align with the Dietary Guidelines and the Guide to Healthy Eating because of the fundamental differences in the basis of these systems. For example, he highlighted discretionary foods under these rubrics that scored well on the HSR, and core foods that scored badly.
Attendees agreed that a key challenge for government was to prioritise healthy eating messages in their campaigns. Delegates to the forum also agreed that the hierarchy of ratings systems ought to be in the following order:
Confidence in the ratings
Other issues considered included use of the qualifier “as prepared”, resulting in misleading ratings for some products. Milo was offered as a prime example, where the product “as prepared” with light milk gets a 4.5-star rating, but the dry product is worth just 1.5 stars. This approach erodes trust in the system, the forum heard.
While consumer confidence in the HSR is reasonably high, the forum agreed that boosting this trust was critical to meaningful implementation and use of the ratings.
Evidence was presented for a greater than 80% concordance between the HSR system and the Dietary Guidelines, but the forum felt that the five-year review presented an opportunity to align these systems much more effectively. Quite a number of attendees, including some who had been quite critical, believed the system — once improved — should be made mandatory as soon as possible.
Broader issues such as nutrition education, extension of the HSR to school canteens, fast foods and fresh vegetables, an obesity action plan and a National Food Plan were canvassed as part of the facilitated discussion.
In concluding the forum, Professor Yeatman encouraged members to see the HSR as a useful tool for better nutrition, but to continue to highlight shortcomings and advocate for its improvement.
Michael Moore is CEO of the Public Health Association of Australia.