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Health Check – a population health approach to helping Canadians make healthy choices

Contents

Health Check

 

I Overview
II Background – how it began
III Health Check today
IV How the program works
V The criteria
VI How Health Check is making a difference
VII Concrete examples
VIII Resources for Canadians
IX Conclusion

-submitted by Carol Dombrow, Heart and Stroke Foundation registered dietitian

 

I Overview

Eating healthy is one of the best things Canadians can do to improve their overall health. Nutritious, balanced meals and healthy snacks can help increase intake of heart-healthy nutrients, manage weight, keep blood pressure down, control blood sugar levels and lower cholesterol. A healthy eating plan can also boost overall feeling of well being, increase energy and vitality, and help people feel better about themselves inside and out.

The Heart and Stroke Foundation encourages Canadians to follow a healthy diet, to eat fresh and cook at home whenever they can, to follow the recommendations in Canada’s Food Guide, and to make healthy choices wherever they are.

But this can be easier said than done.

Canadians are busy and also faced with a vast array of food choices. The healthy choices are not always that obvious, and in some situations, there might not be any healthy options. People know they should cook more and that they should eat more fruits and vegetables and cut down on “other” foods as well as limit sodium, fat and sugar intake.

But given that the healthy choices are not always the easy choices, Canadians need support. The Foundation is committed to helping Canadians lead healthier lives, including making healthier foods choices.

Consider the following facts about Canadians’ eating habits:

  • Canadians of all ages get more than one-fifth of their calories from "other foods," which are food and beverages that are not part of the Four Food groups.  
  • More than one-quarter of Canadians ages 31 to 50 get more than 35% of their total calories from fat, the threshold beyond which health risks increase.
  • More than one-third of children ages 4 to 9 do not have the recommended two servings of milk products a day. By age 30, more than two-thirds of Canadians do not attain the recommended minimums.
  • Seven out of 10 children ages 4 to 8, and half of adults, do not eat the recommended daily minimum of five servings of vegetables and fruit.
  • 56% of Canadians (age 12+) consume fewer than five servings of vegetables and fruit per day.
  • Processed foods are the main source of sodium consumption, accounting for 77% of average daily sodium intake. Another 12% occurs naturally in foods, and salt added during cooking (6%) or at the table (5%) makes up the remainder.
  • Almost 25% of Canadian household food dollars are spent in restaurants.
  • Nearly one in 10 meals and snacks is from a restaurant.
  • There are 62,629 foodservice outlets in Canada.
  • There are 15.8 million restaurant visits by Canadian consumers each day. (Canadian Restaurant and Foodservice News)
  • 70% of shopping decisions are made in the store, at the point of purchase.  (Terry O’Reilly, The Age of Persuasion, CBC Radio)

All references available at the Heart and Stroke Foundation website at http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statis... unless otherwise indicated.

II Background – how it began

Health Check was officially launched to the public in 1999 but work began to plan and develop the program several years before that. In 1995 similar programs existed in the UK and Australia and some nutrition information was available in Canadian stores but nothing on actual products that could inform consumers’ choices by helping them identify healthy choices.

A group of committed staff and volunteers at the Foundation agreed that a food information program would address a need that had been clearly identified by consumers. There was a great opportunity to develop a program that would help Canadians identify healthy choices in the grocery store as well as provide healthy eating information. The Foundation was already providing valuable healthy eating information – and continues to do so. However, the reality is that Canadians make 70% of their purchasing decisions in the grocery store, so a real opportunity to positively influence behaviour lay in identifying healthy products in the stores themselves.

The early components of the program included a front-of-pack logo to identify healthy products and information on why the product was a healthy choice. All products in the program would have to display complete nutrition information in the form of the Nutrition Facts table – a forward thinking concept as the Nutrition Facts were not mandatory at this time. The Health Check logo would provide consumers with a quick visual reference and the nutrition facts provided complete nutrition information.

There were challenges before the program got off the ground including regulatory hurdles with the government and opposition from some professional groups. The development phase lasted several years and champions were able to push the work forward.

As an evidence-based program, a Technical Advisory Committee of registered dietitians and other nutrition experts was assembled to develop nutrient criteria based on recommendations in Canada’s Food Guide and an independent group was retained to perform product evaluations.

The next step was to speak with food companies and convince them of the value of participating in a new health focused front-of-pack program that did not yet have any brand recognition. Exclusivity was also an issue as in early talks some food companies communicated they wanted their product to be the only choice in the category with the Health Check logo. But this was refused as Health Check was not developed as a marketing program for the food industry, but as a tool to help Canadians make healthy choices, with an aim of including as many healthy choices as possible.

In the end companies did see the value in being able to have a credible, neutral organization evaluate and recognize their products as contributing to a healthy diet. The first products joined in 1998 as part of a pilot project and the program was officially launched in 1999, with restaurants coming on board in 2006.

Even in its infancy Health Check had the solid reputation of the Heart and Stroke Foundation behind it and the credibility of its expert nutrition volunteers. The program was developed, and continues, to be a health promotion program based on a population health approach.

III Health Check today

Health Check is one way the Heart and Stroke Foundation helps Canadians eat well.

Overview

Health Check’s goals:

  • Help Canadians make healthy food choices in grocery stores and restaurants.
  • Educate consumers on healthy eating.
  • Challenge and work with the food industry to make the food supply healthier.

At the individual level Health Check helps Canadians make healthy food choices in grocery stores and restaurants by identifying them with the logo.

Health Check and the Heart and Stroke Foundation provide many healthy eating resources for Canadians including tip sheets, recipes, and videos that are disseminated online, in hard copy and through various media.

As a population health intervention Health Check challenges food manufacturers and restaurants to offer more healthy food options. As a result of stronger nutrient criteria, such as reductions in sodium and fat, many food companies and restaurants are either currently working on reducing the amount of salt and/or fat in their food products and menu items or have already done so.

Health Check is the only neutral, third-party, not-for-profit food information program in the country, working with industry in an arm's length relationship to improve the Canadian food supply. The program is evidence-based, national in scope, and enjoys credibility as a program of the Heart and Stroke Foundation.

IV How the program works

Companies must earn the right to use the Health Check symbol.

Health Check is a voluntary program, open to any company or restaurant chain. Food companies, grocery retailers and restaurants must earn the Health Check symbol by submitting products or menu items which are then evaluated by the Heart and Stroke Foundation’s registered dietitians and verified by an independent lab. Only when products or menu items meet the nutrient criteria can they display the Health Check logo.

Products and menu items are also randomly evaluated by an independent lab on a regular basis to ensure they continue to comply with the nutrient criteria.

In many cases, companies reformulate their products or menu items or introduce new healthier options to meet with Health Check’s nutrient criteria.

To help run the not-for-profit program and to develop tools to educate consumers on healthy eating, participating companies and restaurants pay a modest annual licensing fee. This fee is paid only after the food or menu item is evaluated to ensure it meets the required nutrient criteria.

Health Check is run on a cost-recovery basis and is not a fundraiser for the Heart and Stroke Foundation.

V The criteria

The Health Check criteria were developed by the Foundation’s registered dietitians and the Technical Advisory Committee made up of nutrition experts with backgrounds in academia, government and nutrition consulting. The criteria are based on recommendations in Canada’s Food Guide and other evidence, and continue to evolve. They cover nutrients Canadians should consume more of including fibre, and vitamins and minerals, and those Canadians should consume less of including sodium, sugar and fat, especially saturated and trans fat.

The criteria are not evaluated independent of each other – many products or menu items include several criteria if appropriate, for example the criteria for breakfast cereals include fat, trans fat, fibre, sodium and sugar. The nutrient criteria were developed for each food category by looking at the nutrients that would make a difference to the category. For example, in the meat group, protein is not a criteria as all meat products contain protein. However fat and sodium content do distinguish products within this category so they are part of the nutrient criteria.

The criteria are reviewed regularly and continue to evolve. The food industry has no involvement in setting the criteria.

VI How Health Check is making a difference

Changing the food supply

As the program continues to evolve and strengthen, food companies and restaurants make changes to existing items and are challenged to develop new healthy items.

Category changes

Several food categories have been eliminated from the program over the past few years to remain consistent with the recommendations in the Food Guide. These decisions were made after consumer research was conducted and with considerable input from the nutrition experts on the Technical Advisory Committee and from the advice of a Health Check Strategic Advisory Council which was comprised of leaders from across the country with expertise in nutrition policy and science, medicine, marketing, public relations, strategic planning and business development

The following categories are no longer in Health Check (but the Foundation`s registered dietitians continue to provide tips and resources for Canadians to make healthy choices in all food categories):

  • French Fries
  • Olives
  • Cookies
  • Cakes
  • Certain Snacks (chips/crisps and pretzels)
  • Desserts (including frozen dairy desserts and puddings)
  • Milk with added sugar
  • Soy beverages with added sugar levels higher than those found in plain milk.

Putting policy into practice

Trans fat

The Health Check criteria align with the recommendations of the Trans Fat Task Force, a federal group of health professionals, government and industry including the Heart and Stroke Foundation. The recommendations are: trans fat in vegetable oils and soft margarines be no more than 2% of total fat and for all other foods that trans fats be limited to no more than 5% of total fat (some trans fat is naturally occurring.) All products and menu items in the program meet the recommendations.

Sodium

Sodium is a good example of an area where Health Check has made a positive difference. The program is moving in the right direction and supports the Foundation’s commitment to helping Canadians reduce their sodium consumption. The Foundation has been actively working on this front in a number of areas including as a signatory to the Blood Pressure Canada policy statement, in participation and support of the federal Sodium Working Group which released a report in July 2010, by implementing a research agenda for sodium reduction in Canada, and through consumer education.

Health Check is a continuation of this work.

As leading health experts have explained, a good sodium reduction strategy for Canada is essential, but it has to happen over time, not overnight. This will allow time for consumer’s tastes to adapt, and allow companies to reformulate their products.

Health Check is taking this step-wise approach and is directly contributing to this process and is the only program in the country doing this practical work.

VII Concrete examples

  • To meet Health Check criteria, 14 companies removed 500,000 800,000 kilograms of salt from their products in just four years. This is the equivalent of 20 dump trucks of salt being driven out of our food supply. A study will be published in the Canadian Journal of Dietetic Practice and Research in Fall 2011 outlining these results.
  • Extreme Pita launched six menu items nationally with Health Check in April 2011. Health Check worked with this restaurant chain for over a year to ensure the new menu items would meet all the criteria, including sodium, and they have reported that this amounts to the removal of approximately 1 ton of sodium from their menu annually across Canada.
  • In 2007 and 2008, Health Check reduced sodium criteria on a number of food groups by at least 25%, and in some food groups by as much as 70%.  This included the bread category which saw a reduction of 25% (from 480 mg per serving to 360 mg per serving). According to the Canadian Community Health Survey, bread is the source of 14 % of the sodium Canadians consume. With 110 bread and bread products in the program, including market leader Canada Bread, the impact of this change has the potential for significant positive effects on the food supply. Health Check will be reviewing the nutrient criteria on a regular basis with the goal of reducing the sodium levels to meet or surpass the sodium targets Health Canada is developing (continuing the work of the Sodium Working Group). Sodium reduction is challenging especially for a category like bread as sodium adds much more than flavour to the product. Health Check will continue to challenge industry to reduce sodium values.
  • In the Canadian Heart Health Strategy and Action Plan (released February 2009) Campbell Soup Company reported removing nine million teaspoons of salt from its tomato soup alone over five years to meet the Health Check criteria.

VIII Resources for Canadians

The logo itself is a resource for Canadians, by helping them identify healthy choices in the grocery store and in restaurants. Health Check, through Ipsos Reid, has conducted a consumer equity study every year since 2003. The 2011 results reveal that awareness levels are high with 86% of Canadians aware of the logo.  

Health Check website (healthcheck.org or visezsante.org) is updated several times a week with new healthy eating information and resources including surveys, blogs by registered dietitians, recipes, articles, tips, contests, videos, e-newsletter and product and restaurant finders.

The My Heart&Stroke Health Check Recipe Helper app provides Canadians with dozens of heart-healthy recipes including lower-sodium recipes, and healthy snacks and lunches for kids as well as comprehensive nutrition information. With the app, Canadians can create a grocery shopping list and rate their favourite recipes.  The app is free, available in English or French, and  can be downloaded at the Apple, Android, and BlackBerry app stores or at www.heartandstroke.ca/mobileapps.

Health Check develops healthy eating articles for a number of online and print publications across the country in both languages throughout the year.

Registered dietitians attend consumer shows to provide one-on-one healthy eating information to participants.

A 2012 Health Check healthy living calendar featuring Anne Lindsay recipes will be distributed across the country in Fall 2011.

An integrated national back to school campaign is launching August 22, 2011 which will include an online consumer contest with 10 grand prizes of $1000 grocery gift cards, and daily prizes of lunch boxes, knap sacks and water bottles. The contest website can be accessed at healthcheck.org and will include tips and resources, and healthy lunch and snack menus and recipes.

Health Check supports the Canadian Produce Marketing Association Mix it Up campaign, a social marketing initiative aimed at helping Canadians of all ages eat more fruits and vegetables (www.fruitsandveggies.ca).  

IX Conclusion

Health Check is on a journey. The program continues to evolve – the criteria will strengthen, restaurants and food companies will continue to reformulate and develop healthier items, and Canadians” palates will adjust and their eating habits will improve overall. Health Check is moving the dial and making positive changes to the food supply so Canadians will have better access to, and be able to identify, healthy food choices wherever they are.