The Policy Change Concerning Artificial Trans Fats In The Canadian Food Supply
Heart disease (HD) is the second leading cause of death in Canada. Every seven minutes someone dies from a heart attack or stroke. To put this in perspective, that is roughly 33, 000 individuals claimed per year. In 2016, heart disease caused a total of 9. 48 million deaths around the world. HD, generally included under the umbrella term of Non-communicable diseases (NCD) accounts for more deaths than cancer, respiratory diseases, and diabetes. Plus, it’s not just individual lives that are paying the price, the economic burden is felt by the entire nation. A report by the Canadian Heart Health Strategy and Action Plan (CHHS-AP) found that by 2020, total costs are expected to reach $28. 3 billion, with the share of mortality costs increasing to 49%, -6% higher than in 2005. With all that being said, upstream approaches such as preventing, detecting, and managing risk factors associated with cardiovascular disease can result in about $5 billion dollars’ worth of savings for the health system, government, and the Canadian economy. While NCDs affect all kinds of people, irrespective of age or location, research has shown that the weight of disease is disproportionality felt by those in vulnerable circumstances living on low- middle income. In other words, socially disadvantaged people are more likely to get sicker and die sooner than their wealthier counterpart.
The glimmer of hope in these grey statistics, is that the while the prevalence may be increasing, the incidence of disease is in fact declining. However, as Canada’s aging population continues to rise, we as future healthcare professionals must ask ourselves, what is the role of public health in reducing the risk of heart disease? Fortunately, there are many. HD does not happen overnight, in fact many NCDs tend to be of long duration, and are the result of many factors impacted by the Social Determinants of Health. In light of the statistics above, the Government of Canada has recently taken action to eliminate a risk factor that was linked to an increase in HD. Throughout this paper, the policy change I will be narrowing in on is in relation to the recent Health Canada ban that came into effect this past September, eliminating artificial trans fats from the Canadian food supply. Specifically, the elimination of trans fats in the production of pastries, other baked goods, packaged goods, and imported foods.
While public health experts in the field are thrilled to finally see the legislated removal of Trans Fats, this milestone comes over a decade since the Trans Fat Task Force (TFTF) made recommendations to the Minister of Health. Trans fats, also called unsaturated fatty acids became widely produced industrially from vegetable fats starting in the 1950s. They were first designed to help make more food products ‘healthful’ as an alternative to saturated fats, which was associated with CVD at the time. Interestingly enough, we know now that the impact of saturated fats on health might not be as clearly harmful as people once believed. Trans fats are made through the chemical process of adding a hydrogen molecule to liquid oils to turn them into solid form. Thereby, changing the configuration from the nature form to an unstable artificial counterpart. There are no known health benefits of artificial trans fats, they were mainly used by manufacturers to help increase shelf-life, and to create the desired texture for baked goods. What we do know for a fact, is that trans fats increase blood levels of “bad” (low-density lipoprotein) cholesterol and decreases levels of “good” (high-denisty lipoprotein) cholesterol. Moreover, both experimental, and observational have shown trans fats to have detrimental effects on endothelial dysfunction and insulin sensitivity, an important risk factor for Type 2 diabetes.
Personal relevance
As a Masters of Public Health Nutrition and Dietetics student, I am particularly interested in the upstream approaches we can implement to protect the public from known health-related outcomes. Throughout my academic and professional endeavors, I often times find myself learning and unlearning what I thought I knew for certain because the science is always changing. As it is written by Deber and Mah (2014): “evidence is often irrelevant, because ideas about what policies or outcomes we would prefer cannot be proven to be right or wrong”. That being said, from a health standpoint the case against trans fats is well-supported with over twenty years of research. Even though it took so long for political action to take place, this is a tremendous example of how multiple interest groups can work together to come up with a solution to a multifaceted problem. As a future Registered Dietitian, I hope that I can one day impact future legislative and regulatory interventions in my field.
Description of the three I’s: institutions, ideas, interests
Decision making in this policy area falls upon the Federal Government, which has the legislative power under the national concern in the Constitution Act to pass legislation related to national health and welfare. Precisely, it is the Minister of Health in the Canadian Cabinet whom is accountable for overseeing the Federal Governments’ Health Department. The current Minister of Health is Ginette Petitpas Taylor, a Liberal Member of Parliament who was chosen for the role by Prime Minister Justine Trudeau. There are three major health-focused government agencies under the Minister of Health. The first and largest division is Health Canada (HC), who’s responsibility is to maintain and improve the health of all Canadians.
Next is the Public Health Agency of Canada (PHAC), who’s mission is to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. Lastly, is the Canadian Food Inspection Agency (CFIA), a regulatory body dedicated to enhancing the health and well-being of Canada’s people, environment and economy. through safeguarding measures. These three governmental organizations under the Federal institutions make up part of the Health Portfolio, which has an annual budget of over 3. 8 billion dollars. The long hard-fought battle to ban trans fats actually began in the early 2000’s when the Institute of Medicine and Joint WHO/FAO Expert consultation made a recommendation that trans fat intake be limited to less than 1% of overall energy intake. Around the same time, countries in Europe were introducing laws that limited the amount of trans fats to 2% per total fat in food items.
The Government of Canada started to take notice of these changes, and began to frame the negative public health impact of trans fats on heart disease. In 2004, the Food and Drug Relations under the CFIA, made it for mandatory food manufacturers to label the amount of trans fats content on most prepackaged foods. On the Nutrition Facts table, trans fats is now grouped under the same Daily Value as saturated fatty acids since both types raise serum LDL cholesterol. These mandatory labelling regulations, turned out to be influential when it came to time to take further political action in this area. A year after the labeling regulations came into effect, a passage of an opposition motion led by the New Democratic Party in the House of Commons, called upon Health Canada and the Heart and Stroke Foundation of Canada to co-chair a multi stakeholder task force.
The directive of the Trans Fat Task Force (TFTF) was to develop recommendations and strategies “to effectively eliminate or reduce processed trans fats in Canadian foods to the lowest level possible”. The final forty-two page report titled ‘TRANSforming the Food Supply’, discusses why a regulatory approach to effectively eliminate/ reduce trans fat in all processed foods is warranted. In order to reduce potential biases’, knowledgeable individuals from multiple interest groups were included to provide assistance on the subject matter. Members were not expected to put forth their organizations’ opinion on the matter, but to present the evidence in an impartial manner. Task force members included: Health Canada, Heart and Stroke Foundation of Canada, Government, Industry Associations, Voluntary/ NGO sector, Scientific/ Academic Experts. Moreover, several other stakeholders in the food industry, voluntary associations, academia, and scientific experts were invited to attend a consultation in Ottawa to share their insight.
The Task Force consulted Industry members to better understand the barriers and implications they face, and how much time they needed to reduce/ eliminate it from their products. Trans fats are largely in foods like vegetable oil shortening, “stick” hard margarine, commercially prepared baked goods, potato and corn chips. crackers, microwave popcorn and deep-fried foods may take longer than others to modify. In the process of reformulating some of these products, with a healthier fat alternative, the Task Force took into consideration what kind of implications the latter may impose on the food supply chain. While food manufacturers, retailers, oilseed producers and processes all brought forth different suggestions, they all shared the same trans fat reduction goals. For instance, the Canadian Council of Grocery Distributors suggested educating consumers about trans fats/ healthy eating, while Monsanto’s food platform worked on developing a commercialized soybean with reduced linolenic acid (no trans). Similarly, two notable studies conducted by the Agriculture and Agri-Food Canada studies also shed light on the possible impact this may have on the Canadian food industry. Furthermore, consultations with well-known scientists from around the world delved into the health implications of alternatives to PHO, and the population health implications of potential policies for reducing consumption of trans fats. Advocacy groups, such as, the Dietitians of Canada support the recommendations put forth by the TFTF, and continue to support efforts to improve public awareness and education on healthier food choices.
Policy change: the pros and cons
In 2016, Health Canada made an important milestone in the final steps towards banning artificial trans fats, by adding PHOs to Part 1 of the List of Contaminants and Other Adultering Substances Foods. The Federal government wanted to give the food industry sufficient time to find feasible alternatives in their food products. In September of this past year, The Minister of Health, announced that Health Canada’s ban on PHOs is now officially in effect! In other words, it is now illegal to add trans fats to foods sold in Canada- irrespective of how they came into the country. While public health experts in the field are elated to finally see the legislated removal of Trans Fats, this milestone comes over a decade since the health recommendations were proposed by the Trans Fat Task Force (TFTF). The total ban on trans fats plays an important role in Health Canada’s healthy eating strategy, which aims to positively influence the food environment in Canada. For example, one of the objectives of this initiative is to reduce health disparities and ‘protect vulnerable populations’. As mentioned in the introduction, research shows that these groups of people are at disproportionally impacted by the risk factors related to NCDs. This was taken into consideration by the TFTF when deciding whether or not a regulatory approach to banning trans fats was the appropriate choice.
One of the rationales for banning them entirely, was that the benefits would impact the whole population, including vulnerable groups with lower incomes and/ or lower literally skills. In the words of Yves Savoi, the Chief Executive Officer of the Heart and Stroke Foundation of Canada, “This important and final step will eliminate these heart-glogging fats from our food supply, benefitting the health of all people”.
