Sealed Meals

Uncovering, Understanding the Sangkap Pinoy Seal Program

By Jin Paul De Guzman

Perhaps a nationwide survey need not be conducted to back up what we have long known: No matter one's socioeconomic status, no matter one's dietary preferences, processed foods--particularly those that are cheap and easy to prepare--are a mainstay in the Filipino diet. They are regularly in our grocery lists; perhaps the only other food that beats them in terms of popularity is rice.

    Relying too much on the convenience and budget savings offered by processed foods of course has a downside, and we all know it--many nutrients that are necessary for us to go through the day are not always present in processed foods; preservatives and additives that may be safe if taken only in very small amounts get introduced into our bodies more often. The balance--and we all know that balance is the magic word in nutrition--is tipped. As Dr. Rodolfo Florentino, scientific director of the International Life Sciences Institute (Southeast Asia) told MEDICAL OBSERVER last year: "Kung iyon na lang ng iyon, wala ng variety, then it becomes harmful."

Supplementation

    Every year the Department of Health spends millions of pesos in micronutrient supplementation in such groups as very young children and pregnant and lactating women. This is to address three critical issues in micronutrient deficiency--iron deficiency anemia, vitamin A deficiency, and iodine deficiency in women. As the previous National Nutrition Surveys (the last being the 1998 survey; another one is set to be done next year) attest, these remain to be major public health problems. Over the years the incidence has declined, albeit much too slowly; by supplementation, usually done at about the same time as the national immunization efforts, climbing up from the critical level of micronutrient deficiency and related diseases may be sped up.

    Micronutrient deficiency is just one aspect of the nutrition issue, where the bigger problem is protein energy malnutrition. As of 1998 only about 60 percent of children from all over the country weigh normally. All the rest are distributed in the spectrum ranging from underweight to stunted to wasted.

    But how to address protein energy malnutrition--where the first solution is just to get people to eat--when "just get people to eat" is not as simple as it seems? This then reveals a much bigger picture; protein energy malnutrition becomes a likely cause and a predictable result when such big issues as poverty come in.

    Although not a "simple" problem, micronutrient deficiency is relatively more manageable. Supplementation is already in place; food fortification may, as it were, supplement the supplementation program.

Fortification

    Established in 1995 via an administrative order signed by then acting Health Secretary Jaime Galvez-Tan and Bureau and Food and Drugs (BFAD) Director Quintin Kintanar, Sangkap Pinoy came about to "improve the nutritional quality of the nation's food supply," specifically processed foods. By encouraging food manufacturers to fortify their products with Sangkap Pinoy nutrients (vitamin A, iron, or iodine or any combination), "the nutritional quality of the Filipino diet can be improved and maintained." Also, the guidelines are set in place to "avoid over- and underfortification that may create imbalance in the diet, as well as avoid misleading label claims to gain competitive marketing advantage."

    Ms. Adelisa Cifra-Ramos, BFAD deputy director and chair of the Sangkap Pinoy Seal Program (SPSP) technical committee, says that initial reaction to the program was positive. Manufacturers began enrolling their products into the program. To qualify for the seal (which bears the words, "Fortified," "Sangkap Pinoy," "Accepted by the Department of Health," and which micronutrient/s it is fortified with), the manufacturers have to fortify their products with a micronutrient of their choice, and it should satisfy at least one-third of the recommended dietary allowance. After this the BFAD or an accredited laboratory analyzes the product to verify nutritional claims. Once the application is approved, the manufacturers pay a minimal contract fee. They then earn the privilege to put the Sangkap Pinoy seal of acceptance on the product label, display it in the manufacturing plant, and use it in advertising materials, which have to be approved first by the DoH. The products also have to submit to regular random testing, to ensure that the claims remain the same.

    Ms. Ramos says that there are now 25 manufacturers whose products carry the Sangkap Pinoy seal. However, she admits that changes in the Department in terms of leadership and structure have affected the program. "Dahil [dito] parang nag-lie low yung promotion ng government for fortified products, parang [the manufacturers] naging lukewarm din."

    At first the SPSP technical board was composed by representatives from different agencies--the Food and Nutrition Research Institute of the Department of Science and Technology; the National Nutrition Council of the Department of Agriculture; the Bureau of Product Standards of the Department of Trade and Industry; and the BFAD and the now-defunct Nutrition Service of the DoH. The Nutrition Service used to function as a kind of gateway for Sangkap Pinoy applicants. Now that the Nutrition Service is gone--the nutritionists of the Nutrition Service have been distributed to different agencies--and most of the DoH restructured, the interagency technical committee gave the full control of the SPSP to BFAD.

    The changes of course brought about some adjustments, but Ms. Ramos says that now everything is in place, and "parang pumi-pick-up na [the interest in the program]." She says there are new applicants to the program, and those with the Sangkap Pinoy seal still renew every year.

    At present 115 variants of 52 products have the Sangkap Pinoy Seal of Approval. The most popular fortificant is vitamin A (72 variants). Iron is used in two products. Vitamin A is also present in combination with iron (25) or iodine (two). All three fortificants are present in a total of 13 product variants.

Information

    The truth is, people are consuming Sangkap Pinoy products without knowing they are Sangkap Pinoy products, or without knowing what Sangkap Pinoy is in the first place. As shown by the 1998 National Nutrition Survey (NNS), 97.4 percent of Filipino households use Sangkap Pinoy products. Awareness of the Sangkap Pinoy seal is low at 16.7 percent, while awareness of fortified foods in general is lower at 11.6 percent. The survey explained this as "Consumption of processed foods either with or without the Sangkap Pinoy seal has already been a part of the Filipino consumers' food habit."

    Ms. Ramos admits that this observation points to the limited promotion being done for the Sangkap Pinoy Program. While these products are already popular by themselves, she says promoting what the seal is about and what it does should be intensified. "Hindi pa siguro naiintindihan ng consumer yung seal na yun," she says. "Kailangan pa siguro ng paliwanag."

    In July the DoH created a steering committee that shall take charge of promoting the food fortification program. Chaired by undersecretary Antonio Lopez, the steering committee shall be composed of three subcommittees focusing on health promotion in the following groups: food manufacturers, wholesalers, and retailers; consumers, educators, and media; and local chief executives and policy makers. These subcommittees are composed of individuals coming from government, nongovernment, and industry organizations such as the DoH, the FNRI, the Philippine Information Agency, the United Nations Children's Fund, and Minola Cooking Oil, among others. The different subcommittees, Ms. Ramos says, aim to "synchronize and integrate communications approaches" to the food fortification program.

Habits

    Instant noodles may well be the unofficial other staple food. Whatever the brand or flavor, Filipinos consume them, and in large quantities: it turns out that there are particular instant noodle brands that some people would consume more than once daily.

    Dr. Demetria Bongga, president of the Nutritionist-Dietitians Association of the Philippines and professor of nutrition of the University of the Philippines College of Home Economics, says that the consumption of noodles is not necessarily a bad thing. She says that mothers now give it to a child as the first food in place of lugaw. "I'm glad they were able to put vitamin A and iodine into it, and they can put fat into it," she says. "That's good." However, she believes that the salt content of the noodles should be significantly lowered if it were to be given to a child.

    While she was with Unicef, Dr. Bongga was part of the group that really pushed for the iodization of salt. She was also initially involved with the Sangkap Pinoy program, and she believed that making manufacturers fortify their products is a way of "making them give the consumers really good products." Also there is the Philippine Food Fortification Law of 2000, which necessitates the fortification of rice with iron, sugar with vitamin A, flour with vitamin A and iron, and oil with vitamin A by November 7, 2004.

    Ms. Ramos informs MEDICAL OBSERVER that at present five of 12 flour millers have already fortified their products with vitamin A. Also, the technology that allows the fortification of sugar has been installed in one of the biggest sugar mills in the country, and the National Food Authority is distributing fortified rice in government feeding projects.

    Meanwhile, Dr. Bongga adds that the Food Development Center is now working to fortify rice with iron. She says that the move to get sugar manufacturers to fortify their products is modeled after the successful sugar fortification programs of Guatemala and Ecuador.

    Dr. Bongga, however, has expressed some reservations in the number of "junk foods"--curls, chips, and other such products--in the list of products that bear the Sangkap Pinoy seal. She believes these are not exactly ideal vehicles for fortification. "Ang kaso, yung may-ari ng junk foods mas gusto nilang [i-fortify their products]," she says. "Para sa kanila may added value e."

    Ms. Ramos says the reason behind the presence of quite a number of junk foods in the list of fortified products is "popular na yan sa low-income group, in fact minsan ulam nila yan. Imbis na pabayaan mong ganoon--sa ayaw at sa gusto mo'y binibili rin nila yan--gawin mo nang vehicle ng mga micronutrients na kulang sa araw-araw."

    She adds: "We don't believe in such a thing as junk food. Paano magiging junk food yan nagbibigay din ng calories yan…ng fats, ng carbohydrates?" But won't the fortification of junk foods somehow communicate the message that it is all right to consume them, that they are good substitutes for a well-balanced meal? "Education ang kailangan diyan," she quickly says.

Prospects

    There are, still, many good things that are coming about due to the food fortification program. Ms. Ramos says that there is an ongoing study in Magalang, Pampanga on vitamin A-fortified products and the children that consume them. Vitamin A deficiency, based on the results of the 1998 NNS, remains a major public health problem in 13 of the country's 16 regions. In the study children are grouped into three: those who don't consume any vitamin A-fortified products; those who consume one to five varieties; and those who consume six to ten varieties. It turns out that nearly a third (29.8 percent) of those who don't consume any still have major vitamin A deficiency. For those consuming between one and five varieties, the problem goes down to 19.1 percent. In the third group, only 10.8 percent have serious vitamin A problems.

    Dr. Bongga adds that vitamin A supplementation in children under five years has also started making significant gains. In a barangay in Batangas, a study has found out that vitamin A deficiency is no longer that big a problem. "Kabibigay, kabibigay, nagbunga na rin."

    Ms. Ramos hopes to see food fortification finally take over micronutrient supplementation. "Supplementation is expensive," she explains. "Samantalang pag nag-fortify, wala nang supplementation, millions ang matitipid ng government. At the same time there will be people empowerment [because people shall take charge] of the nutrients na kailangan nila through the buying of fortified foods."

    But will the food fortification program already have an impact in next year's NNS? She answers: "Hindi pa siguro malaki. Kasi nakita mo naman after six years ganito pa rin. Siguro after another ten years magkakaroon na. Hopefully."