Noncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out 57 million global deaths). Eighty per cent of NCDs deaths worldwide occur in low- and middle-income countries like Pakistan. Even a cursory glance at Pakistan’s Country NCD Profile reveals that Pakistan faces a major NCD problem since NCDs account for 58% of all deaths in Pakistan, more than half of them due to cardiovascular disease (CVD).
This has heightened implications for health policy makers in post Covid-19 Pakistan, given growing evidence that people living with NCDs like diabetes and hypertension are at higher risk of severe symptoms and death from coronavirus. A growing NCD burden as heavy as the one borne by Pakistan has the potential to quickly spiral into a raging health crisis if adequate measures are not taken today.
Many of the common causes of NCDs relate to dietary intake. Socio-economic development in Pakistan, like in many other developing countries, has been accompanied by major changes in dietary patterns. Traditional foods have been increasingly replaced by processed foods. A large part of Pakistan’s NCD burden can be attributed to increased consumption of unhealthy foods — including high levels of sugar, salt and processed fats — which greatly increase the risk of developing food-related NCDs like CVDs, diabetes, and even some cancers (together, these three account for over half of all NCD deaths in Pakistan). Recent studies by WHO Pakistan have ascertained that commonly available Pakistani food products contain far higher than recommended levels of trans fat, salt and sodium.
Food-related NCDs are perfectly preventable and thus theoretically more than half the NCD deaths in the country can be avoided by promoting healthy eating and eliminating unhealthy ingredients from people’s diet. Accomplishing this requires a wide range of coordinated moves both in the regulatory/legislative as well as the consumer domain. The actions required in the latter essentially boil down to one thing: consumer empowerment.
Ideally, an empowered consumer is one that can make informed decisions about the products she or he consumes, has awareness, is informed regarding her or his rights, knows what to do and where to go in case they are violated, and has options to choose between a range of quality and healthy products.
Inequality among consumers in terms of education and literacy levels hampers their ability to make healthier food choices. Together with inequalities in purchasing power, consumers in Pakistan are less protected particularly in the backdrop of how the food industry demonstrates lack of concern about communicating or addressing health risks associated with their products.
In Pakistan, consumer rights are protected by law but question marks hang over the efficacy of these protections on the ground. The current consumer protection framework consists of consumer protection acts by the federal and provincial governments and consumer courts for complaint redressals. Pakistan's first consumer protection act, the Islamabad Consumer’s Protection Act, was passed in 1995. After that, the provinces followed suit and Khyber Pakhtunkhwa(KP), Balochistan, Punjab and Sindh enacted laws in 1997, 2003, 2005 and 2014 respectively. Overarchingly, all of the provincial consumer rights acts address three major concerns of consumers: pricing, labeling and damages and penalties in case of failure to comply with obligations.
One major shortcoming of paramount importance in Pakistan’s consumer protection framework is the implementation mechanism for consumer protection. This implementation framework relates to which state organs are mandated to ensure consumer rights, how they go about it , how penalties are imposed, how complaints are redressed and how vigilance and surveillance is kept to ensure consumer rights are protected 24/7.
Most provinces have thus far failed to establish functional consumer protection councils at provincial and adequate consumer courts at district levels as envisioned in their acts — most districts in Punjab for instance still lack consumer courts. Lack of policy prioritisation and funding shortages have meant that consumer protection institutions remain pitifully understaffed.
For enforcing food-related consumer rights, all provinces have provincial food authorities. The bulk of the focus of the activities of food authorities has been around issues of food safety and hygiene without much attention towards food composition, sources of ingredients and labeling enforcement. This lack of focus on composition and formulation results in a consumer protection framework that is not geared toward tackling food-related NCDs.
In the crucial area of labelling, the KP, Balochistan, Punjab and Sindh Consumer Acts make it obligatory for all manufacturers to "publish or mark on every packet or container the maximum retail price, the nature, standard or type and other specifications of the goods therein, the weight, size or volume and date of manufacturing and expiry". However, the effectiveness of these labelling requirements is diluted given the low literacy levels in the country and lack of awareness of nutritional requirements, which makes labelling and nutrition information in English of little practical use to most consumers.
One possible solution to this that has been employed as best practice in developing countries around the world is colour coded labelling practices like the Traffic Light System — TLS, a three-colour-based coding mechanism that can be used to designate food products as high risk (red), low risk (amber) and risk free (green). This could empower a wide range of consumers despite low literacy rates, making it easier for them to make healthier food choices.
Even where nutrition regulations are followed, misleading nutrition information continues to be a major problem. Packaged milk for instance has some formaldehyde added to it to increase shelf life. Formaldehyde is not proven to be safe for human consumption and the nutritional facts on the packaging of such milk does not clearly mention the presence of formaldehyde in that product. Manufacturers need to be forbidden by law to conceal actual additives on such labels by generic terms like “preservatives”. Consumers have the right to full knowledge of both actual ingredients, including sources of ingredients, nutritional facts of those ingredients, as well as information about the manufacturing processes that have been applied to a particular packaged food product as all these factors affect the health and well-being of the consumer.
In theory, the provincial consumer protection acts also impose damages/fines/compensations upon manufacturers for violating food safety and quality regulations. However, the penalties are generally far too low — usually in the range of tens of thousands of rupees — to function as an effective deterrent for large companies and proportionately compensate for the damage done to public health. Further, while fines can be imposed by the government for violations, it is rare that actual affectees are redressed for damages in most cases. Moreover, these penalties are uneven across provinces, further eroding their effectiveness.
Additionally, the rate of filing of complaints of Consumer Rights Violation in Pakistan is very low despite frequent violations. The first and foremost reason is a lack of awareness of rights on the part of consumers, of which all other reasons are either a direct or indirect consequence. Consumers are largely unaware of their rights and uninformed of the implicit warranties, protections, and health hazards in the foods that they purchase. It is due to this lack of awareness of their rights that consumers in Pakistan have been largely reduced to a helpless lot of exploited individuals. Furthermore, the complaints process in Pakistan is too laborious and time-intensive. Ideally, a rights-aware consumer should be able to file complaints through digital and telephone mechanisms, but no such measures currently exist.
Another prime reason for high consumer rights violation and low consumer complaints in Pakistan is the absence of unionised consumer bodies. For a functional framework of consumer protection, there need to be effective platforms for self-organisation that can orchestrate coordinated actions to protect consumer rights. Unionised consumers enjoy a far better negotiating capacity. However, Pakistan has a total of two non-government consumer organisations — The Network and Consumer Rights Commission of Pakistan (CRCP) — for a population of over 200 million. Furthermore, a plethora of regulatory bodies and ombudsmen create more confusion rather than facilitating the average consumer. For instance, within the services segment, the presence of the National Electric Power Regulatory Authority, the Oil and Gas Regulatory Authority, the Pakistan Telecommunication Authority, the banking ombudsman, health regulatory authorities, food regulatory bodies and insurance ombudsman all have contributed to eroding or minimising the effectiveness of consumer courts.
Lastly, in addition to the total absence of consumer rights from the Constitution, no case laws (the law developed over time by judges in superior courts) on consumer protection have been established in Pakistan. Therefore, not many precedents have been set for the judges of lower courts (who run the consumer courts) to follow.
To summarise, Pakistan’s consumer protection framework leaves much to be desired and this is contributing to growing ill-health from NCDs. The deeply fragmented and unenforced system of consumer protection laws points towards a lack of nationwide federal level concern/commitment for the protection of consumer rights.
To address this, an effective, well-financed implementation framework of consumer protection councils, courts, and consumer organisations needs to be established. The framework needs to be proactive and responsive and it needs to take action far beyond complaints redressals: ranging from raising awareness levels of the population, strengthening the financing and capacity of consumer protection institutions, updating labelling and food composition regulations to international standards, facilitating the unionisation of consumers, to equipping consumers with the right digital and/or other tools to ensure that they have adequate protection.
More importantly, the issue of protecting consumer rights should not be seen exclusively from a market lens but from a public health viewpoint. Fixing some of these issues can help to reduce the NCD burden in Pakistan and prepare the country for any future health emergencies.
Ihtiram Khattak is Senior Manager, Health Financing stream at Heartfile, a think-tank focusing on improving health systems in Pakistan and other developing countries. Khattak can be contacted at firstname.lastname@example.org
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