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FOOD AT WORK

WORKPLACE SOLUTIONS FOR MALNUTRITION, OBESITY

AND CHRONIC DISEASES
The author

Christopher Wanjek is a freelance health and science writer based in the United
States. He is a frequent contributor to The Washington Post and popular science
magazines, and he is the author of Bad medicine: misconceptions and misuses
revealed. Mr. Wanjek has a Master of Science in environmental health from Harvard
School of Public Health.
FOOD AT WORK

WORKPLACE SOLUTIONS FOR MALNUTRITION,

OBESITY AND CHRONIC DISEASES

Christopher Wanjek

INTERNATIONAL LABOUR OFFICE • GENEVA

Copyright © International Labour Organization 2005
First published 2005

Publications of the International Labour Office enjoy copyright under Protocol 2 of the
Universal Copyright Convention. Nevertheless, short excerpts from them may be
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countries with associated Reproduction Rights Organizations, may make photocopies in
accordance with the licences issued to them for this purpose.

Wanjek, C.
Food at work: Workplace solutions for malnutrition, obesity and chronic diseases
Geneva, International Labour Office, 2005

ILO descriptors: provision of meals, food service, occupational health, occupational

safety, developed country, developing country. 13.08

ISBN 92-2-117015-2

ILO Cataloguing in Publication Data

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The responsibility for opinions expressed in signed articles, studies and other contributions
rests solely with their authors, and publication does not constitute an endorsement by the
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endorsement by the International Labour Office, and any failure to mention a particular
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 FOREWORD

The rights to safe drinking water and to freedom from hunger are basic human
rights and yet all too often ignored in the context of rights at work. Equally,
they are an essential foundation of a productive workforce, and yet also all too
often ignored in the context of productivity improvement and enhanced
enterprise competitiveness. Measures to ensure a properly fed and healthy
workforce are an indispensable element of social protection of workers, and
yet frequently absent from programmes to improve working conditions and
occupational safety and health. And despite the fact that these concerns are
indeed fundamental ones for both employers and workers, they all too rarely
feature as topics for social dialogue.
Food at work is therefore inextricably linked to the pillars of the ILO’s
Decent Work Agenda. It touches not only on questions of nutrition, food
safety and food security, although these in themselves are important enough.
But it also calls into question other basic issues of working and employment
conditions: wages and incomes, since workers – and their families – cannot eat
decently if they do not receive an adequate income; working time, since
workers cannot eat decently if their meal break is too short, or if their shift
requires them to work at times when food is not available; and work-related
facilities, since workers’ health will be affected both by the quality of what
they eat and drink at work and the conditions in which they consume it (such
as protection from workplace chemicals and other hazards).
The importance of food at work is reflected in the Millennium
Development Goals which set targets of halving, by 2015, the proportion of
people who suffer from hunger and those without sustainable access to safe
drinking water and basic sanitation. These targets are not only to be met at the
workplace, but the workplace is an essential place to make a start. This
recognition is not new: food at work was recognized as a building block of
social justice in the 1944 Declaration of Philadelphia concerning the aims and

v
Food at work: Workplace solutions for malnutrition, obesity and chronic diseases

purposes of the ILO, which recognized the ILO’s obligation “to further
among the nations of the world programmes which will achieve: … the
provision of adequate nutrition, housing and facilities for recreation and
culture”.
This book was conceived as a response to the lack of attention to the
issue of food at work. It aims to show not simply why this issue is important
– that is rather easily done – but also, and more importantly, what employers,
workers and governments can do and what they have done to improve food at
work. It is intended as a practical rather than a theoretical contribution. We
hope that amongst the many examples of good practice from around the world
that are presented here, some will seem useful, relevant and replicable to the
readers. These examples, taken from a wide range of countries and enterprises
– from multinationals operating in highly industrialized countries to small-
scale enterprises in developing countries and countries in transition – show
that every business can benefit from improved attention to food at work. They
also provide evidence that improvements – whether through improved
cafeterias or mess halls, the introduction of meal voucher programmes,
working with local vendors and others to improve street foods, or the
provision of safe drinking water – are within the reach of any business, even
the smallest. Furthermore, they demonstrate the active role that can, and
indeed must, be played in this process by workers and their organizations, as
well as the role for governments.

François Eyraud, Director

William Salter, Senior Adviser
Conditions of Work and Employment Programme
Social Protection Sector

vi
 CONTENTS

FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

PART I NUTRITION AND THE WORKPLACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1 THE HISTORY AND ECONOMICS OF WORKPLACE NUTRITION . . . . . 9

1.1 The price of poor nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.2 Nutrition as an element of a healthy workplace . . . . . . . . . . . . . . . . . . . . . 13
1.3 The rationale for government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.3.1 Obesity and the non-communicable disease epidemic . . . . . . . . . . 14
1.3.2 The lingering malnutrition problem . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.3.3 Savings through diet and exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1.3.4 Underestimated cost of poor occupational safety and health . . . . 18
1.4 The rationale for employers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1.5 The rationale for employees and unions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

2 A NUTRITION OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.1 Energy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.2 Macronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.2.1 Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.2.2 Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.2.3 Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

vii
Food at work: Workplace solutions for malnutrition, obesity and chronic diseases

2.3 Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.3.1 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.3.2 Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.4 Other nutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

3 THE WORKPLACE AS A SETTING FOR GOOD NUTRITION . . . . . . . . . 37

3.1 Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.2 The law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
3.3 Food solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3.3.1 Cost and place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3.3.2 Time, timeliness and rest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.3.3 Comfort and accessibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3.4 Marginalized employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
3.4.1 Non-core workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
3.4.2 Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
3.5 Occupational safety and hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
3.6 Special diets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3.7 International equality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

PART II CASE STUDIES: FOOD SOLUTIONS FROM THE FIELD . . . . . . . . . . 55

4 CANTEENS AND CAFETERIAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

4.1 Dole Food Company, Inc. (California, United States) . . . . . . . . . . . . . . . . 62
4.2 San Pedro Diseños, S. A. (Guatemala City, Guatemala) . . . . . . . . . . . . . . . 67
4.3 Spotlight on Canada: Government and unions help improve
workers’ nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
4.4 Husky Injection Molding Systems Ltd. (Ontario, Canada) . . . . . . . . . . . . 77
4.5 Placer Dome, Inc., Musselwhite Mine (Ontario, Canada) . . . . . . . . . . . . . 82
4.6 Akteks Akrilik Iplik A. S. (Akteks Acrylic Yarn Industry and
Trade Company) (Gaziantep, Turkey) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
4.7 Tae Kwang Vina (Dong Nai, Viet Nam) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.8 Spotlight on Singapore: The Workplace Health Promotion Programme . . 94
4.9 Glaxo Wellcome Manufacturing Pte Ltd. (Singapore) . . . . . . . . . . . . . . . . 98
4.10 Spotlight on Austria: Light, healthy and fair eating in the workplace . . . 102

viii
 Contents

4.11 Voestalpine Stahl GmbH (Linz, Austria) . . . . . . . . . . . . . . . . . . . . . . . . . . 105

4.12 PSA Peugeot Citroën (Rennes, France) . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
4.13 Wellmark Blue Cross Blue Shield (Iowa, United States) . . . . . . . . . . . . . . 114
4.14 WMC Resources – Phosphate Hill (Queensland, Australia) . . . . . . . . . . 117
4.15 Spotlight on Argentina: Hard economy, hard habits . . . . . . . . . . . . . . . . . 122
4.16 Unilever (Buenos Aires, Argentina) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
4.17 Total Austral (Patagonia, Argentina) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
4.18 Moha Soft Drinks Industry S. C. (Addis Ababa, Ethiopia) . . . . . . . . . . . 131
4.19 Kotebe Metal Tools Works Factory (Addis Ababa, Ethiopia) . . . . . . . . . 134
4.20 McMurdo Station (Ross Island, Antarctica) . . . . . . . . . . . . . . . . . . . . . . . 138
4.21 Ministry of Defence and Armed Forces (United Kingdom) . . . . . . . . . . 143
4.22 Canteens and cafeterias summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

5 MEAL VOUCHERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

5.1 Meeting a social need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
5.2 Tax revenue and boost to local economies . . . . . . . . . . . . . . . . . . . . . . . . . 156
5.3 Types of vouchers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
5.4 Voucher pros and cons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
5.5 Successes and new possibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
5.6 Brazil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
5.7 Hungary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
5.8 Romania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
5.9 France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
5.10 United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
5.11 Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
5.12 India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
5.13 Lebanon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
5.14 China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
5.15 Meal vouchers summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

6 MESS ROOMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

6.1 MexMode (Atlixco, Mexico) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

ix
Food at work: Workplace solutions for malnutrition, obesity and chronic diseases

6.2 Boncafé International (Singapore) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296

6.3 K. Mohan and Co. (Bangalore, India) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
6.4 Spotlight on an NGO: The Global Alliance for Workers
and Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
6.5 Spotlight on California: 5-a-Day Worksite Program and
Task Force on Youth and Workplace Wellness . . . . . . . . . . . . . . . . . . . . . . 219
6.6 American Apparel (California, United States) . . . . . . . . . . . . . . . . . . . . . 223
6.7 San Mateo County Municipality (California, United States) . . . . . . . . . . 227
6.8 Russian-British Consulting Centre
(Rostov-on-Don, Russian Federation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
6.9 Spotlight on Bangladesh: Turning the page on poor workers’ nutrition . 234
6.10 Bangladesh garment sector: I Garments, Bantai Industries
and MVM Garments (Dhaka, Bangladesh) . . . . . . . . . . . . . . . . . . . . . . . . 239
6.11 Simbi Roses (Thika District, Kenya) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
6.12 Kenya Vehicle Manufacturers Ltd. (Thika Town, Kenya) . . . . . . . . . . . . . 250
6.13 Agricultural workers’ nutrition: Lessons from Uganda . . . . . . . . . . . . . . 254
6.14 Mess rooms summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

7 REFRESHMENT FACILITIES AND LOCAL VENDORS . . . . . . . . . . . . . . 263

7.1 Kaiser Permanente of Northern California
(Oakland, California, United States) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
7.2 Five-a-day: The fruit and vegetable movement . . . . . . . . . . . . . . . . . . . . . 272
7.3 Firmafrugt: Danish Workplace Fruit Initiative . . . . . . . . . . . . . . . . . . . . . 275
7.4 Street foods and workers’ nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
7.4.1 Calcutta, India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
7.4.2 Bangkok, Thailand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
7.4.3 Gauteng Province, South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
7.4.4 Dar es Salaam, Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
7.5 Construction sites: No canteen for those who build canteens . . . . . . . . . 303
7.5.1 United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
7.5.2 Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
7.5.3 Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
7.5.4 China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305

x
 Contents

7.6 Onojo City junior high schools (Fukuoka, Japan) . . . . . . . . . . . . . . . . . . 307

7.7 Spotlight on Japan: The Japanese o-bento – Zen and the art
of the packed lunch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
7.8 Healthy foods for meetings, seminars and catered events . . . . . . . . . . . . 312
7.9 Local vendors summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315

8 SOLUTIONS FOR FAMILIES (low-cost shops, provision

of food rations, dormitories) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
8.1 Pfizer Canada (Quebec, Canada) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
8.2 United Laboratories Inc. (Manila, Philippines) . . . . . . . . . . . . . . . . . . . . . 323
8.3 Spotlight on the Russian Federation: Worker and family nutrition
during and after the Union of Soviet Socialist Republics . . . . . . . . . . . . . 325
8.4 10-BP (10th Bearing Plant) (Rostov-on-Don, Russian Federation) . . . . 329
8.5 Dormitories for female garment workers in Bangladesh . . . . . . . . . . . . . . 333
8.6 Solutions for families summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336

9 CLEAN DRINKING WATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339

9.1 The office water cooler culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
9.2 Portable, potable water and bottle-less solutions . . . . . . . . . . . . . . . . . . . . 345
9.3 Russian-British Consulting Centre (Rostov-on-Don,
Russian Federation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
9.4 Tai Yang Enterprise Co. Ltd. (Phnom Penh, Cambodia) . . . . . . . . . . . . . 349
9.5 National Aeronautics and Space Administration Goddard
Space Flight Center (Maryland, United States) . . . . . . . . . . . . . . . . . . . . . 352
9.6 Confection et Emballage (Port-au-Prince, Haiti) . . . . . . . . . . . . . . . . . . . 354
9.7 Clean drinking water summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356

PART III RESOURCES FOR UNIONS, EMPLOYERS AND GOVERNMENTS 359

10 A CHECKLIST FOR ENTERPRISE DECISION-MAKING . . . . . . . . . . . . . 361

10.1 Canteens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
10. 2 Vouchers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
10.3 Mess rooms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
10.4 Kitchenettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
10.5 Mobile refreshment facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368

xi
Food at work: Workplace solutions for malnutrition, obesity and chronic diseases

10.6 Vending machines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368

10.7 Local vendors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
10.8 Options for different types of organization . . . . . . . . . . . . . . . . . . . . . . . . 370

11 INTERNATIONAL STANDARDS, POLICIES AND PROGRAMMES . . . 373

11.1 International Labour Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
11.1.1 Canteens and food services in industry: A manual . . . . . . . . . . . . . 378
11.1.2 ILO SOLVE Programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
11.1.3 Draft Consolidated Maritime Labour Convention . . . . . . . . . . . . 379
11.2 Global perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
11.2.1 WHO: Global Strategy for Food Safety . . . . . . . . . . . . . . . . . . . . . . 380
11.2.2 WHO: Global Strategy on Diet, Physical Activity
and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
11.2.3 United Nations: Fifth Report on the World Nutrition Situation:
Nutrition for Improved Development Outcomes . . . . . . . . 380
11.2.4 WHO/World Bank: Food policy options: Preventing
and controlling nutrition related non-communicable diseases . . . . . 381
11.3 Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
11.3.1 WHO/FAO: Diet, nutrition and the prevention of chronic
diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
11.3.2 WHO/FAO: Preparation and use of food-based dietary
guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
11.3.3 USAID/UNICEF/WHO: Nutrition essentials: A guide for
program managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
11.3.4 WHO/UNICEF/UNA: Iron deficiency anaemia: Assessment,
revention and control. A guide for programme managers . . . . . . . . 383
11.4 Food safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
11.4.1 Public Sector Food Procurement Initiative (England) . . . . . . . . . 384
11.4.2 Codex Alimentarius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
11.4.3 Hazard Analysis Critical Control Point (HACCP) system
for food safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
11.4.4 Participatory Hygiene and Sanitation Transformations
(PHAST) Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
11.4.5 WHO: Guidelines for drinking-water quality . . . . . . . . . . . . . . . . 387

xii
 Contents

11.4.6 FAO: The economics of food safety in developing countries . . . . . . 388

11.4.7 FAO: Training manual for environmental health officers
on safe handling practices for street foods . . . . . . . . . . . . . . . . . . . . . 389
11.5 Health education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
11.5.1 The Ottawa Charter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
11.5.2 The Jakarta Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390

12 CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
12.1 Governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
12.1.1 Tax incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
12.1.2 Health promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
12.1.3 Laws on break times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
12.1.4 Laws on meal provision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
12.1.5 Street foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
12.2 Employers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
12.2.1 Access to meals and rest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
12.2.2 Local vendors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
12.2.3 Health education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
12.2.4 Monetary incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
12.2.5 Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
12.2.6 Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
12.3 Workers and trade unions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
12.3.1 Trade Unions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
12.3.2 Workers’ committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
12.4 Concluding comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399

APPENDIX A MACRONUTRIENTS: PROTEINS, FATS AND

CARBOHYDRATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

APPENDIX B MICRONUTRIENTS: VITAMINS, MINERALS

AND OTHER NUTRIENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421

INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431

xiii
Food at work: Workplace solutions for malnutrition, obesity and chronic diseases

FIGURES
3.1 The cycle of poor nutrition and low national productivity . . . . . . . . . . . . . . . . . . 42
3.2 The food solution continuum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
3.3 Decisions on food solutions might come down to budget and space . . . . . . . . . . 53
5.1 The voucher scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
5.2 Total number of workers (in thousands) benefiting from the PAT, 1977–97 . . . 169
5.3 Total number of participating companies, 1977–97 . . . . . . . . . . . . . . . . . . . . . . . 169

TABLES
2.1 Ranges of population nutrient intake goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
5.1 Meal vouchers of the world . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
5.2 Meal voucher system in Brazil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
5.3 Meal voucher system in Hungary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
5.4 Meal voucher system in Romania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
5.5 Meal voucher system in France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
5.6 Meal voucher system in the United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
5.7 Meal voucher system in Sweden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
5.8 Meal voucher system in India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
5.9 Meal voucher system in Lebanon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
6.1 Food intake by income in rural Bangladesh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
6.2 Caloric intake of selected workers in Bangladesh . . . . . . . . . . . . . . . . . . . . . . . . . 236
6.3 Nutrient intake of landless workers in Bangladesh – all below
WHO recommendations except for carbohydrates . . . . . . . . . . . . . . . . . . . . . . . 237
7.1 Ways to reduce saturated fats and calories in catered food . . . . . . . . . . . . . . . . . . 313

BOXES
2.1 Dietary sources of fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
11.1 The Welfare Facilities Recommendation, 1956 (No. 102) . . . . . . . . . . . . . . . . . . 374

xiv
 ACKNOWLEDGEMENTS

The author would like to acknowledge the valuable contributions of the

following people at all stages of the book: Suzumi Yasutake, Mariano
Winograd, Vladimir Usatyuk, Susanne Tøttenborg, K.C. Tang, Vivien Stone,
Beatrice Spadacini, Jørgen Schlundt, Marta Senyszyn, William Salter, Chris
Rochette, Richard Rinehart, Gerhard Riess, Nathalie Renaudin, Dries
Pretorius, James Platner, Robert Pederson, Jane Paul, Sarah O’Brien, Dara
Nov, Biplap Nandi, Alice Mwangi, Franklin Muchiri, Gerald Moy, Golam
Mowlah, Richa Mittal, Joann Lo, Nathalie Liautaud, Anne Lally, Jutta Kellner,
Belay Kassahun, Edín Rolando Pop Juárez, Juan Carlos Hiba, Lyle Hargrove,
Thierry Guihard, Elizabeth Goodson, David Gold, Sylvia Fulgencio, Franceen
Friefeld, Laurent Fourier, Valentina Forastieri, Kristine Falciola, Patrick
Dalban-Moreynas, Edward Croushore, Mabel Chia-Yarrall, Indira
Chakravarty, Enrico Casadei, Alexandra Cameron (co-author for parts of
Chapter 1), Joannah Caborn, H. Müge Çamligüney, Eric Boulte, Gopal
Bhattacharya, Bruno de Benoist, Charlotte Beauchamp, Jacqueline Baroncini,
Omara Amuko, and all the company and union representatives who provided
information for the case studies.

xv
 INTRODUCTION

Why workers’ nutrition is important

• Nearly a billion people are undernourished and one billion are overweight or obese;
a stark contrast of the haves and have-nots (WHO, 2004a).

• Workplace meal programmes can prevent micronutrient deficiencies and chronic

diseases, including obesity. Investments in nutrition are repaid in a reduction of sick
days and accidents and an increase in productivity and morale.

• Access to healthy food (and protection from unsafe and unhealthy food and eating
arrangements) is as essential as protection from workplace chemicals or noise.

• Adequate nourishment can raise national productivity levels by 20 per cent

(WHO, 2003a).

• A 1 per cent kilocalorie (kcal) increase results in a 2.27 per cent increase in general
labour productivity (Galenson and Pyatt, 1964).

• Increasing the average daily energy supply to 2,770 kcal per person per day with
adequate nutrients in a sample of countries could have increased the average annual
GDP growth rate by nearly 1 per cent each year between 1960 and 1990 (Arcand, 2001).

• Iron deficiency affects up to half the world’s population, predominantly in the

developing world (Stoltzfus, 2001). Low iron levels are associated with weakness,
sluggishness and lack of coordination.

• As much as a 30 per cent impairment in physical work capacity and performance

is reported in iron-deficient men and women (WHO, 2001, p. 30).

• Micronutrient deficiencies account for a 2–3 per cent loss in GDP in low-income
countries; and in South Asia, iron deficiency alone accounts for a loss of
US$5 billion in productivity (Ross and Horton, 1998, p. 38).

1
Food at work: Workplace solutions for malnutrition, obesity and chronic diseases

• Hypoglycaemia, or low blood sugar, which can occur when one skips a meal, can
shorten attention span and slow the speed at which humans process information
(McAulay et al., 2001).

• Obesity accounts for 2–7 per cent of total health costs in industrialized countries
(Kumanyika et al., 2002).

• In the United States, the total cost attributable to obesity calculated for 1995
amounted to US$99.2 billion (Wolf and Colditz, 1998).

• Studies have shown that obese workers are twice as likely as fit workers to miss
work (Wolf and Colditz, 1998).

• In 2001, non-communicable diseases contributed to about 46 per cent of the

global disease burden and 60 per cent of all deaths worldwide, with cardiovascular
disease alone amounting to 30 per cent of deaths (WHO, 2002a, p. 188). The
global disease burden from non-communicable diseases is expected to climb to
57 per cent by 2020 (WHO, 2003b, p. 4).

• The diabetes epidemic is particularly acute in the South Pacific, where the percentage
of total health-care resources allocated to this disease is 6 per cent in Fiji, 10 per cent
in the Federated States of Micronesia, 14 per cent in the Marshall Islands and 14 per
cent in the Cook Islands (WHO Regional Office for the Western Pacific, 2003).

Workers’ meal programmes are good for workers, good for business and good for
the nations.

This book addresses a simple question – how do workers eat while at work?
This question, we have found, is not always given much thought. This is
strange, as food is the fuel that powers production. One would think that
employers, wanting to maximize productivity, would provide their workforce
with nourishing food or, at the very least, convenient access to healthy food.
What we have found in researching material for this book is that workplace
meal programmes are largely a missed opportunity. It is a salient fact that world-
wide nearly a billion people are undernourished while over one billion are
overweight. How do we address this catastrophic misappropriation of food
resources? The World Health Organization (WHO) and the Food and
Agriculture Organization (FAO), among other international bodies, have taken
great steps in remedying malnutrition through projects focused on better food
supply chains, storage, land management, food fortification, bulk food distrib-
ution and education. Our view, in assisting this global aim, is that the workplace
should be a locale for meal provision and nutrition education initiatives.

2
 Introduction

Too often the workplace meal programme is either an afterthought or not

even considered by employers. Work, instead of being accommodating, is
frequently a hindrance to proper nutrition. Canteens, if they exist, routinely
offer an unhealthy and unvaried selection. Vending machines are regularly
stocked with unhealthy snacks. Local restaurants can be expensive or in short
supply. Street foods can be bacteria laden. Workers sometimes have no time to
eat, no place to eat or no money to purchase food. Some workers are unable
to consume enough calories to perform the strenuous work expected of them.
Agricultural and construction workers often eat in dangerous and insanitary
conditions. Mobile workers and day labourers are expected to fend for
themselves. Migrant workers, far from home, often find themselves with no
access to local markets and no means to store or cook food. Night shift-
workers find they have few meal options after hours. Hundreds of millions of
workers face an undesirable eating arrangement every day. Many go hungry;
many get sick, sooner or later. The result is a staggering blow to productivity
and health. Poorer nations, in particular, remain in a cycle of poor nutrition,
poor health, low productivity, low wages and no development.
Presented in this book are mostly positive examples of how governments,
employers and trade unions are trying to improve the nutritional status of
workers. In wealthier nations, where obesity and related non-communicable
diseases – cancer, diabetes, cardiovascular disease and kidney problems – are
epidemic, we find some employers offering healthier menus or better access to
healthier foods, such as on-site farmers’ markets. In developing and emerging
economies, where hunger and micronutrient deficiencies such as anaemia are
epidemic, we find some employers offering free, well-balanced meals or access
to safer street foods.
Chapter 1 provides governments, employers and workers with a rationale
for embracing a proper workplace meal programme. Governments gain from a
well-nourished population through reductions in health costs, through tax
revenue from increased work productivity, and – in feeding its children –
through the security of future generations of healthy workers. The savings are
significant. In Southeast Asia, iron deficiency accounts for a US$5 billion loss
in productivity. In wealthier nations, obesity accounts for 2 to 7 per cent of
total health costs. In addition to these costs, employers must understand that
poor nutrition is tied to absenteeism, sickness, low morale and higher rates of
accidents. Obesity, inadequate calories and iron deficiency result in fatigue and
lack of dexterity. Employees must understand that their health and thus job
security is dependent upon proper nutrition. The workplace can be an
instrument for eating well.
Chapter 2 is an overview of nutrition, complemented by Appendices A
and B. Chapter 3 demonstrates how the workplace is the logical setting for

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