Key Stakeholder Perspectives on Introducing a Front-of-Pack Labelling Scheme on Packaged Foods in China: A Qualitative Study.

Xuejun Yin,Yuexin Yang,Xin Xin,Lin Xiang,Alexandra Jones,Simone Pettigrew,Wei Liu,Lihong Ye,Kehan Wen,Ruijie Yan,Juan Zhang,Maoyi Tian,Yue Yu

doi:10.3390/nu14030516

Abstract

Front-of-pack (FoP) labelling on foods is recommended by the World Health Organization (WHO) to address the growing global burden of diet-related noncommunicable diseases (NCDs), but this policy has not yet been implemented in China. The aim of this study was to ascertain key stakeholders’ views on barriers and facilitators to developing a feasible and acceptable FoP labelling policy in the Chinese context. Semistructured interviews were used to elicit opinions from diverse representatives in roles of FoP labelling policy influence. Participants were identified by purposive and snowball sampling. The Consolidated Framework for Implementation Research (CFIR) was adopted to facilitate data collection and analysis. Themes and subthemes were generated using deductive and inductive approaches. Thirty participants were interviewed. The major barriers were the absence of national contextual analysis, perceived complexity of the process of policy development, disagreement on a preferred FoP labelling format, cost for the food industry, low priority compared to food safety policies, lack of existing regulatory framework or authorised nutrient profiling system, limited knowledge of FoP labelling, and the lack of planning and engagement with stakeholders. Facilitators included existing prerequisites, experiences and lessons from the pilot, policy coherence with Healthy China 2030, and support from external agents (e.g., WHO). Further efforts are required to develop and collate evidence to demonstrate the scientific, legal, and political feasibility of introducing effective FoP labelling.

Highlights

Noncommunicable diseases (NCDs) are the leading cause of death both worldwide and in China [1,2]
Stakeholders were not convinced by the current evidence that a large proportion of the NCD burden in China is attributed to packaged food
Many key stakeholders would benefit from access to knowledge synthesis of the global evidence on FoP labelling in tandem with the development of national evidence to support the development of a national FoP label

Summary

Introduction

Noncommunicable diseases (NCDs) are the leading cause of death both worldwide and in China [1,2]. To address the hazardous effects of dietary risk factors on NCDs, the Chinese government issued the General Rules for Nutrition Labelling of Packaged Foods (GB28050) in 2010, which were implemented as a mandatory standard in 2013. These rules require manufacturers to present quantitative information on the energy, protein, fat, carbohydrate, and sodium content of foods, and provide a list of ingredients on food packages [9]. Consumer understanding and use of this information on the backof-pack remains very low [10] To supplement this more detailed nutrition information, simple, graphical Front-of-Pack (FoP) labels have emerged as a feasible and acceptable strategy to facilitate healthier food purchasing [11]. The World Health Organization (WHO) recommends implementing FoP labelling as a “Best Buy” (i.e., cost-effective) intervention to combat NCDs [12]

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