The policy dystopia model adapted to the food industry: the example of the Nutri-Score saga in France

In October 2017 in France, the government recognized the Nutri-Score front-of-pack labelling system as the only official system to be used on food products. As of July 2018, a total of 70 companies had implemented it voluntarily. There is ample evidence to support its use, and multiple expected benefits in terms of public health. We present here an essay discussing about the Nutri-Score saga. A policy dystopia model, from the literature on tobacco industry tactics, was adapted to classify the corporate political activity of the food industry during the development and implementation of the Nutri-Score. We conclude that, despite public commitments made by some industry actors to implement this system, the food industry is still strongly trying to influence policy and public opinion in the country. There are and will be many hurdles along the way, with food industry members trying to influence regulation at the European level, and building alliances with the media, among others, in France. Hopefully, public health objectives will prevail over commercial interests, in France and abroad.


Introduction
In October 2017 in France, the government recognized the front-of-pack (FOP) nutrition labelling system named Nutri-Score as the only official system to be used on food products (LegiFrance 2018). The European regulation (EU) number 1169/2011 refrains member States from introducing mandatory FOP labelling (European Parliament, Council of the European Union 2011). Therefore, Nutri-Score is now voluntarily implemented by some food companies, as later described in this essay.
The Nutri-Score is a summary, graded, color-coded system providing information on the overall nutritional quality of a food product using a 5-scale scheme (from A/Green to E/Red). This nutrient profiling system was adapted from the UK Food Standard Agency Nutrient Profiling System, and takes into account the nutrient contents of food and drink products (Haut Conseil de la Santé Publique 2015). There is ample evidence to support its use, and multiple expected benefits in terms of public health (Ducrot et al. 2015, Ducrot et al. 2015, Ducrot et al. 2016). However, this came after a long process that included intense interference from the food industry. Industry has lobbied worldwide against FOP nutrition labelling for decades, as exemplified by its €1 billion action against a 'traffic light' system in Europe in the early 2000s (Corporate Europe Observatory 2010). In France, since the first proposal to use the Nutri-Score on food products in 2014, the food industry has strongly opposed such a system, and tried first to block, and then to delay, its implementation Hercberg 2016, Mialon M andJ 2018).
The term "corporate political activity" (CPA) refers to attempts made by corporations to influence public policy and public opinion in ways favorable to the industry (Baysinger 1984). This is a term derived from the business literature but is also used in public health research (Baysinger 1984, Hillman and Hitt 1999, Savell et al. 2014, Mialon et al. 2015, Savell et al. 2016. The CPA of the tobacco industry has been thoroughly studied, based on access to internal documents from the tobacco industry after litigation against large transnationals in the late 1990s (State of California -Department of Justice -Office of the Attorney General 2017, University of California San Francisco 2017). There is an existing framework, adapted from the tobacco control literature and developed by the first author, for classifying the CPA of the food industry (Mialon et al. 2015). This framework was adapted for this essay, following the recent publication of an updated model for classifying the CPA of the tobacco industry (Ulucanlar et al. 2016). The dystopia mode consists of a list of so-called instrumental strategies (Table 1) that are employed to influence policies and public opinion, and a list of discursive strategies used in arguments by the food industry (Table 2). These various strategies are referred to parenthetically in the rest of this paper.  (Mialon et al. 2015) and Ulucanlar et al. (Ulucanlar et al. 2016  Policy will lead to reduced sales/jobs Cost of compliance will be high Frame the debate on diet-and public health-related issues Stress the good traits of the food industry Shift the blame away from the food industry and its products, e.g. focus on individual responsibility, role of parents, physical inactivity Promote industry´s preferred solutions: education, balanced diets, information, public private initiatives, self-regulation (reformulation) We reviewed materials published in scientific journals discussing the food industry influence on Nutri-Score development and implementation. We conducted additional searches online for recent events. Two of us were personally involved in the Nutri-Score development and implementation, and have observed the industry practices, which have contributed to the shaping of this essay. In the text, where appropriate, we have included the name of each instrumental strategy in brackets.

Initial food industry opposition to Nutri-Score
In France, the food industry has used different instrumental and discursive strategies to oppose, delay and influence the development of the Nutri-Score. We describe them here, related to the categories listed in Tables 1 and 2. Instrumental strategies There is evidence, although limited, in the scientific literature, that the food industry has employed instrumental strategies to influence public health policy and public opinion.
The then Minister of Health supported the implementation of the Nutri-Score system, a position described as "dogmatic" by the ANIA (Association Nationale des Industries Agroalimentaires/National Association of Agribusiness Industries) (Mialon M and J 2018). It is the largest trade association for the food industry in France [coalition management strategy] (Mialon M and J 2018). In addition, the industry tried to stop research conducted by Professor Hercberg and his team (who developed the Nutri-Score system), by lobbying directly to the Ministry of Agriculture [information management strategy] (Julia and Hercberg 2016).
The industry was also directly involved in policy making. In 2015, a health law was under discussion in France, and included the principle of a FOP nutrition labelling (Julia and Hercberg 2018). During the legislative process, the Ministry of Health organized a consultation with all stakeholders, including food industry actors, to specifically discuss an inter-ministerial decree on FOP labelling (Julia and Hercberg 2018). While the decree was under discussion, the industry lobbied for an experiment in real-life conditions, and a comparison between different types of labels, including labels developed by the industry [direct involvement and influence in policy making] . In December 2015, the Health law was adopted without a requirement for an experiment . However, an experiment on the impacts of different labels was later commissioned, and led by an organization directly affiliated with the food industry, with partial funding received from food industry actors, as described elsewhere [information management strategy] . Results from this experiment showed that the Nutri-Score was the most effective FOP nutrition labelling system, among the systems tested (Ministère des Solidarités et de la Santé 2016).

Discursive strategies
Actors from the food industry used several arguments to try and influence the decision on the implementation of the Nutri-Score.
The food industry suggested that the implementation of the Nutri-Score would lead to unanticipated costs to the economy ("a war on prices") and society .
In the early discussions about the Nutri-Score, food industry actors such as ANIA described the Nutri-Score system as simplistic (Mialon M and J 2018), discriminatory Hercberg 2016, Mialon M andJ 2018), incomplete (Mialon M and J 2018), and taking a medicalized approach to eating (Mialon M and J 2018). Alternatives to the proposed Nutri-Score system were introduced by the industry as early as 2014 (Mialon M and J 2018). Actors such as Coca Cola, Mc Donald's and Nestlé suggested that their own system was clearer, more accessible, and more factual (Mialon M and J 2018).
Actors in the food industry also framed the issue of FOP labelling in ways favorable to themselves by claiming to be part of the solution (not the problem) (Mialon M and J 2018), while shifting the blame to consumers. They stressed the idea that individuals have to make food choices that are good for their health (Mialon M and J 2018). Furthermore, the food industry claimed that there was not enough evidence that the Nutri-Score was effective, despite abundant scientific evidence of its effectiveness Hercberg 2016, Mialon M andJ 2018). The industry thus claimed that the Nutri-Score was not needed (Mialon M and J 2018).
These discursive and instrumental strategies may have shaped public opinion, but certainly succeeded in delaying the implementation of the Nutri-Score (Julia and Hercberg 2016).
In 2017, France notified the European Union of its plan to introduce an inter-ministerial decree on the Nutri-score labelling system (European Commission 2017). After consultation with members States, the notification period ended on 25 October 2017, allowing the country to go further with the implementation of the system (European Commission 2017). Despite the interference exerted by the food industry documented here, the decree was introduced in France on 31 October 2017, and recognized as the official FOP nutrition labeling system to be used in France (LegiFrance 2017). Nine months after the introduction of this decree, more than 70 companies committed to implementing the Nutri-Score system on all of their products for the specific brands for which they made a commitment (Santé Publique France 2018).
The industry is still using political strategies against the Nutri-

Score system
The food industry is still trying to influence public policy and public opinion in France, but also in other parts of Europe with regard to the issue of FOP nutrition labelling. We describe them here, again referring to the categories listed in Tables 1 and 2 The ENL is a modified version of the British "traffic light" system, which itself is less effective than the Nutri-Score . Moreover, thresholds for deciding on the color (specifically 'amber' or 'red, the unhealthiest color) in these FOP labelling are slightly different from those used in the original "traffic lights" system, resulting in more products being classified as amber rather than red compared to ENL labelling . Among these six academics, only one was a nutrition researcher. Two others were food technologists, two worked in marketing, and the remaining person was a psychologist Just a few weeks before the introduction of the inter-ministerial decree that supported the Nutri-Score, a trade association, the "Alliance 7" (representing sectors such as the producers of candies, breakfast cereals and snacks), wrote a letter to its industry members, advising them to adopt the ENL system (UFC-Que Choisir 2017). Among the members of the Alliance 7 are some of the industry actors who were involved at the beginning of the ENL initiative (Mars, Mondelez, Nestlé and PepsiCo) (Alliance 7 2018). The Alliance 7 is located at the same address as the ANIA and the 'Federation Française des Industriels Charcutiers Traiteurs' (FICT, or French Federation of Industrial Catering Butchers), but also the Association des Brasseurs de The heads of major TV channels and media outlets wrote a joint letter to the government and to several ministries, including the Ministry of Health, the Ministry of Agriculture and the Ministry of Education (Arrêt sur images 2018). In this letter, the heads of TV channels claimed that the amendment bill was a threat to their industry, and would lead to a loss of profits, as these were largely generated from advertisements paid by the food industry (650 million euros, or 20% of the market) (Arrêt sur images 2018). And because TV channels are important funders for the production of films in France and Europe, they also claimed that the amendment bill would have an impact on artistic development (Arrêt sur images 2018). The letter was signed by trade associations and individuals in the audio-visual industry too (Arrêt sur images 2018).
The signatories claimed the adoption of the amendment bill would threaten the 130,000 jobs in the media sector (Arrêt sur images 2018).
The media described its self-regulatory efforts, by highlighting existing public private initiatives, where the media industry was part of the solution (Arrêt sur images 2018).
Signatories of this letter proposed to continue working with policy makers and actors in the food industry (Arrêt sur images 2018). In their letter, the media supported alternatives to regulation, such as education, emphasizing its commitments to promote "good eating behaviors and healthy lifestyles", particularly among children (Arrêt sur images 2018). In this type of argument, the responsibility for making wise food choices rests entirely on consumers, with no help from the industry. The amendment bill was rejected in May 2018 (Assemblée Nationale 2018).

Conclusions
Despite strong resistance from the food industry, the Nutri-Score was adopted in France, almost four years after the first discussions about it began at the Ministry of Health. During this period, the food industry used several political strategies and there are probably many more examples of CPA strategies that have never been and will never been known to the public, due to the difficulty in accessing that type of information (such as personal contacts between food industry representatives and policy makers). As demonstrated in this essay, there are a lot of similarities between the CPA of the food industry and the CPA used by the tobacco industry to influence public health policies (Ulucanlar et al. 2016).
To counter the industry's push against the Nutri-Score system, a petition was signed by more 250,000 people in support of it (Delannoy 2017). A second petition was launched in June 2018 to support the amendment bill for the use of the Nutri-Score on advertisements (Courtois 2018). Just a month after its launch the petition had attracted more than 90,000 signatures (Courtois 2018).
Despite all efforts made by the government to be transparent, inclusive, and to consider the requests made by the food industry, there is still much work to do to implement the Nutri-Score on all products and all advertisements. The Nutri-Score is a voluntary system for FOP labels, not yet applicable to advertisements, as described earlier. The reality is that, today, with no harmonization at the European level, most food companies do not use any FOP system, and large transnationals are using their own alternative systems.
Research on Nutri-Score and other FOP labelling systems, but also on other public health policies, should be strengthened and supported by governments. In addition, French policy makers could promote the mandatory use of Nutri-Score at the European level.
Consumers could develop their own initiatives, as it is the case with mobile applications that scan products and provide their Nutri-Score (Yuka 2018), even when it is not displayed on the product label. Food industry actors could adopt this FOP labelling system on all their products, and for their advertisements. Finally, we believe the precautionary principle should be adopted, with no involvement of the food industry allowed in policy making.
There are and will be many hurdles along the way, with food industry members trying to influence regulation at the European level, and building alliances with the media, among others, in France. Hopefully, public health objectives will prevail over commercial interests, in France and abroad.