Protecting Heart Health in India
India is in the midst of a public health crisis fueled by an influx of ultra-processed foods and rise of lifestyle diseases. The country approved strict limits on a particularly harmful food component, trans fat, following strategic advocacy by a coalition of partners support by the Global Health Advocacy Incubator (GHAI).
India’s trans fat burden
Cardiovascular disease (CVD) is the leading cause of death worldwide, and India accounts for more than one in five of these deaths. The country also has one of the highest proportions of CVD-related deaths due to trans fat intake: Approximately 144,443 of more than 2.2 million CVD deaths were linked to trans fat consumption in 2019, according to an analysis of Global Burden of Disease data.
India has a long history of regulating trans fat: In 2011, the country capped trans fat content at 10% of total fat in fats and oils, a measure that was reduced to 5% four years later. But these limits were rarely enforced, and they did not cover all foods. They also did not meet the World Health Organization’s (WHO’s) call to eliminate industrially produced trans fat from the food supply by 2023.
GHAI’s role: Making the case for trans fat elimination
A coalition of partners supported by GHAI started advocacy in 2018 with the Food Safety and Standards Authority of India (FSSAI), the relevant regulatory agency, to make the case for trans fat elimination in line with WHO recommendations. Together with our partners, we:
- Organized meetings with FSSAI and public health advocates to build consensus around international best practices and worked with Resolve to Save Lives and others to provide technical comments on draft regulations.
- Supported a growing coalition of civil society leaders calling for strict, mandatory trans fat limits, positioning them as a nutrition priority and important part of FSSAI’s Eat Right India movement, and neutralizing opposition arguments using science-based arguments.
- Conducted research on healthier alternatives to partially hydrogenated oils (PHOs), a major source of dietary trans fat intake, and engaged decision-makers and experts about ways to boost the availability of healthier oils.
- Conducted an earned and digital media campaign to highlight the harms of trans fat and push for strong regulation.
Building momentum during the pandemic
Throughout the COVID-19 pandemic, GHAI and partners conducted public awareness activities and participated in political events to make the case for trans fat elimination. At one such event, on August 17, 2020, a representative from the Ministry of Health and Family Welfare acknowledged the importance of safer foods and their impact on non-communicable diseases (NCDs), and FSSAI Chief Executive Officer Shri Arun Singhal delivered a speech pushing for expeditious notification of trans fat regulations.
Demonstrating public support
Eliminating trans fat is an ambitious undertaking in a country like India, with its rich culinary traditions and widespread popularity of foods cooked in trans fat-rich PHOs. For the longest time, Indian media paid little attention to trans fat – focusing instead on other food and health challenges.
To expand the conversation, GHAI worked with FSSAI and others to generate media coverage on trans fat harms and solutions, putting a spotlight on trans fat regulation as a nutrition priority. GHAI helped partners to:
- Cultivate recognized medical professionals, nutritionists and opinion leaders as campaign champions.
- Create earned and digital media opportunities to make the case for trans fat elimination.
- Build the capacity of journalists and digital influencers to speak up about trans fat.
- Conduct media monitoring and develop rapid response strategies to address policy developments and opposition attacks.
Catalyzing media coverage
GHAI designed a series of journalism workshops to engage national news outlets and journalists in states with a particularly high burden of NCDs. More than 300 journalists participated in these events throughout 2019 and 2020, including in Delhi, Kerala, Madhya Pradesh, Maharashtra, Punjab and Telangana. Each workshop was tailored to match cultural and political realities and featured high-level political decision-makers who affirmed their commitment to public health. They also allowed the decision-makers to interact with journalists as well as reputed food scientists and health practitioners.
The workshops resulted in widespread and sustained media coverage. Organizers continued to engage workshop participants throughout the campaign, sharing new information and story ideas, and turning important media gatekeepers into campaign allies.
Generating state-level momentum
GHAI mapped political and industry stakeholders in key states and studied the capacity of relevant authorities to implement trans fat measures. We supported civil society partners to build lasting relationships with state-level food authorities and worked with them to educate food safety officers about the importance of testing food products for trans fat.
Growing public awareness generated by our partners helped to catalyze political action. In Maharashtra, Kerala and Telangana, for example, key decision-makers publicly declared their support for trans fat elimination. In Punjab, a media workshop hosted by one of our partners served as a curtain raiser for a state-wide campaign to eliminate artificial trans fat, with the state’s food commissioner pledging support.
Piloting solutions in Punjab
Punjab established the first government lab in the country’s north with the ability to test for trans fat in food and developed a framework for quarterly testing of oils and fats produced and distributed in the state.
GHAI mapped oils and fats produced and distributed in Punjab across manufacturing sites, retailers and distributors, helping state authorities to get a clear picture of products containing trans fat. In 2019, Punjab became India’s first state to ban ghee (a popular type of clarified butter), which surveillance data found was not exclusively derived from milk fat but also made with PHOs. By banning ghee, Punjab was able to limit the consumption of trans fat from a highly popular food staple.
Victory
FSSAI approved two regulations in December 2020 and February 2021 requiring trans fat to be reduced to less than 2% of total fat by January 1, 2022 – a year ahead of the WHO-recommended schedule – in all food products in which edible oils and fats are used as an ingredient.
Lessons Learned
- Government engagement and ownership is key to successful policy change campaigns.
- Advocates should prepare for industry groups to oppose public health campaigns that threaten their revenues.
- Media can be used to build and demonstrate broad support for trans fat elimination and other health priorities.
- Strategic and technical assistance can help civil society advocates to conduct effective campaigns that build on international experiences and best practices.
- Coalitions – particularly those that feature partners with diverse strengths and constituents – are critical to success.
- State governments can be powerful allies in advancing trans fat elimination measures.
- Policy change often needs to be supported by capacity strengthening for implementation.