Still from Cover Image GI2021

ATNI is pleased to present the fourth iteration of the Global Access to Nutrition Index, following on from editions published in 2013, 2016, and 2018.

This Index, like its predecessors, assesses how the world’s largest global food and beverage (F&B) manufacturers contribute to addressing malnutrition in all its forms: overweight and obesity, undernutrition, and micronutrient deficiency. Together, the Global Indexes are an important tool to advance ATNI’s vision of a world in which no one goes to bed hungry, and everyone eats a healthy, affordable diet that has all the nutrients and food groups needed to grow and develop fully in good health. As a result, death and illness from diets low in essential vitamins and minerals would be  confined to history.

Download the Executive Summary

Twenty five leading F&B manufacturers are included in the 2021 Global Index. All have been assessed on their commitments, practices, and disclosure – with regards to governance and management; the production and distribution of healthy, affordable, accessible products; and how they influence consumer choices and behavior.

There are several changes compared to the previous Global Index. In 2018, undernutrition was presented in a separate section; now, policies and actions targeting priority populations at high risk of malnutrition are woven throughout. Also added into the Index this year (as criteria B1) is a section assessing and scoring the healthiness of companies’ product portfolios, their performance within product categories among peers, and changes over time. You can find the full methodology, and details on the changes, here.

Furthermore, previous Global Indexes incorporated a sub-ranking that assessed the marketing policies and practices of the world’s largest makers of breast-milk substitutes (BMS). For the 2021 edition, ATNI has published this assessment as a stand-alone Index and extended it to include an evaluation of the marketing of complementary foods (CF). The BMS/CF Marketing Index 2021 has been expanded from the six largest to the nine largest companies in this sector, by global revenues. Six of these companies are constituents of the Global Index 2021, and their final Global Index score depends in part on their BMS/CF Marketing Index 2021 score.

The Global Index is used by an increasing number of interested parties (policymakers, investors, international and non-governmental organizations (NGOs), and others) to hold the private sector accountable in delivering on commitments to tackle growing nutrition challenges worldwide. These challenges have never been more evident, as the COVID-19 pandemic has widened inequities, increased poverty, and impacted on malnutrition in all its forms. Despite the progress made over the last two years, as shown by this Index, companies still need to do much better by putting in place even stronger commitments to improving food systems and fighting malnutrition. With 2021 being the Nutrition for Growth Year of Action, now is the time for F&B  manufacturers to step up, scale up, and make a difference to healthier diets for everyone, everywhere.

ATNI invites you to share the Global Index 2021 across your networks – and please do not hesitate to get in touch if you have any questions.

Press release

Learn more about the context of this index

The malnutrition crisis


Overall, the 2021 results show that companies need to enhance their efforts to encourage healthier diets for all. The average score remained the same as 2018, at 3.3 out of 10. All 10 leading companies, except for Arla, scored lower than in the 2018 iteration, while most companies in the middle and lower rankings scored slightly higher. Similar to 2018, Nestlé leads the 2021 rankings with a score of 6.7 out of 10. The company achieves a top-three rank in all categories of the Index and rates first in ‘Governance’ and ‘Engagement’. Unilever comes second with 6.3, and FrieslandCampina third with 5.9. Arla showed a big improvement from 3.3 in 2018 to 5.1 in 2021, securing a rank of fifth in the Index; in part due to a new labeling policy, responsible marketing policies, and an improvement in healthiness of its product portfolio. Meanwhile, Meiji rose five places in the Index, partially due to its incorporation of a nutrition strategy in its CSR vision and new policies aimed at marketing to children and labeling.

Assessed in the BMS/CF Marketing Index 2021. An adjustment based on the BMS/CF Marketing Index score is incorporated into the overall Global Index 2021 score.
Did not provide information to ATNI


The findings of this Index regarding companies’ performance rely to a large extent on information shared by companies, in addition to information that is available in the public domain. Several factors beyond the companies’ control may impact the availability of information such as differences in disclosure requirements among countries or capacity constraints within companies, amongst others the Covid-19 pandemic. Therefore, in the case of limited or no engagement by such companies, this Index may not represent the full extent of their efforts.

Please find more information on our methodology and changes in this on the Methodology page.

Company scorecards

The 25 largest global food and beverage manufacturers were selected for inclusion in the 2021 Global ATNI based on 2018 companies’ publicly reported and self-reported sales revenues combined with estimated retail sales of packaged food and beverage products worldwide.

Key findings

While some companies have shown significant progress since 2018, on average, the industry has only made small improvements. With progress from the top 10 ranking manufacturers seemingly slowing down, ATNI urgently calls on companies to step up their efforts to tackle some of the world’s toughest nutrition challenges.


Selected Best Practices

    • A

    FrieslandCampina’s programmeBroadening access to nutrition, aims to make foods and beneficial nutrients available to more people, especially those with lower incomes. Seanuts II and ANI research projects provide the company with information for products and fortifications needed to help combat undernutrition and micronutrient deficiencies in children up to 12 years old and women of reproductive age in markets in Asia and Africa. The studies’ results are published in the public domain.

    • B

    Danone disclosed its benchmark on alignment of its definition of healthy categories with HSR. Danone’s ‘healthy categories’ are benchmarked against the HSR and the information is publicly disclosed .The percentage of healthy products in Danone’s portfolio is 90% according to the company’s own criteria, and accounts for 88.3% of sales (water represents about two-thirds of Danone’s total sales in volume) when utilizing the HSR healthy threshold (HSR >=3.5). In the Product Profile, a total of 1,626 products across 10 markets were assessed for Danone, and 997 (61 percent) met the ‘healthy’ threshold. The company uses volume data excluding plant- based products, whilst the Product Profile utilized retail sales including the plant-based segment- one of the reasons the company’s figures differ from those of the Product Profile.

    • C

    Nestlé has developed and updated its commercial strategy, known as Popularly Positioned Products (PPP), to address the affordability of products meeting its own nutrition criteria, including those aimed at addressing micronutrient deficiencies across all its market operations. To appropriately price healthy products whilst considering the needs of low-income consumers, the company has an Integrated Commercial Planning process in place. This aims to review pricing of Nestlé’s healthy products falling within the scope of its Popularly Positioned Products strategy, globally. The company also demonstrated examples of its application in various markets. In terms of distribution, the company shares evidence from Bangladesh through which it reaches “deep rural marginal outlets” to ensure the availability and accessibility of healthy Nestlé products to rural consumers. Its focus on priority populations is substantiated with examples of various products designed to address micronutrient deficiencies (e.g., the Bear Brand in South-East Asia).

    • D
    • F

    Arla is the only company to specifically refer to children as persons under the age of 18 years, as defined by the Convention on the Rights of the Child (CRC). In its policy, the company includes all children under the age of 18 and specifies which part of the policy applies to all children below 18 years and which part to children below 12 years. No other company extends the age range of its policy so high as under the age of 18.

    The company stands out because of its broad commitment and public disclosure on the appropriate use of claims. The ‘Arla Foods’ labelling policy’ aims to ‘’create a uniform approach to packaging labelling with regards to the use of illustrations and information, including nutrition and health information, on all Arla Foods amba branded products, globally, to ensure simple and accurate product information to enable consumers to make informed dietary choices.’’  

    Arla has company specific nutrition criteria and states that they only allow the use of nutrition and health claims on products that meet these. The company commits to use national systems or guidance to get approval for nutrition and health claims and, if none exist, will only use claims in line with the Codex standards. 

    • E

    Unilever’s award-winning Lamplighter Program is an innovative approach to employee wellness, using health risk appraisals alongside exercise, nutrition, and mental resilience to improve employees’ health and wellbeing. Aggregated review results show that the Lamplighter programs offer a high return on investment, indicating that good health really is good for business. Unilever states this program is key to addressing the top three health risks across their business: mental wellbeing; lifestyle factors (such as exercise, nutrition, smoking, obesity); and ergonomic factors (such as repetitive strain injury).

    Unfortunately, during the COVID-19 pandemic, Unilever has had to run the Lamplighter program at reduced capacity. In 2020, 42 countries ran the Lamplighter employee health program, reaching around 32,000 employees, and the “Employee Assistance Program” also supported employees through the pandemic.

    Unilever is one of eight companies that demonstrated a commitment to improving the health and wellness of groups across the wider food supply chain. These groups are not direct employees (such as smallholder farmers, factory workers, and small scale vendors).  The company’s partnership in the ‘Seeds of Prosperity’, with GAIN and the Sustainable Trade Initiative (IDH), is helping tea workers and their families improve their health and wellbeing through more nutritious, diverse diets. The findings of this program will be utilized by all three groups to develop the next generation of workplace nutrition programs, with the aim of developing an approach which can be adapted to suit different businesses and contexts.

    ATNI strongly encourages other food and beverage manufacturers to step up their efforts in this field.

    • G

    In their latest ‘Wellbeing Milestones’ report, Kellogg describes in detail its engagement with numerous governments in the US, Latin America, and Europe to address hunger and malnutrition among children from low-income households. Kellogg also states that it actively engages in ongoing conversations with multilateral organizations, governments, and NGOs to identify risks and opportunities, inform new programs and food innovations, and further inform its Wellbeing Strategy, commercial strategy, and corporate policies on undernutrition.

  • Show all


Category A: Governance
Companies that scored highly on governance tended to score better across other Categories, too – suggesting that nutrition activities are likely to be better sustained where commitment starts at the top, and are integrated into core business strategy and publicly and comprehensively reported on.

Therefore, ATNI recommends that global F&B manufacturers continue to integrate nutrition considerations into core business functions, including linking executive pay to performance on nutrition objectives. These commitments could then be translated into specific action, and research conducted into how best to use commercial opportunities to address specific needs of priority populations.

Category B: Products
Companies can and must do much more to develop and deliver a comprehensive strategy to improve the overall nutritional quality of their portfolios and within product categories. Product innovation, reformulation, diverging from unhealthy product lines, and/or acquiring healthier brand lines will improve company scores on all three components of the Product Profile assessment (portfolio healthiness, within category healthiness, and change in healthiness over time).

ATNI recommends that global F&B manufacturers disclose nutrient information (including micronutrients) for all products, to enable more robust independent assessments of the nutritional quality of products (such as ATNI’s Product Profile). Companies must improve transparency on the proportion of sales from healthy products and ensure their targets on portfolio level healthiness (e.g., through divestment/ acquisition) and product (re)formulation are aligned with national and international standards.

ATNI also recommends that companies commit to only fortify products that are healthy and inherently of high quality in addressing undernutrition, and that strategies and R&D investments are strengthened to develop products addressing micronutrient deficiencies.

Category C: Accessibility
ATNI recommends that global F&B manufacturers adopt a clear policy on affordability and accessibility of healthy products, including strong, unifying public commitments and SMART (specific, measurable, achievable, realistic, and timely) targets to guide their actions.

Most companies need to strengthen their current commitments by specifically addressing the needs of low-income consumers and/or those that lack physical access to nutritious food, across all markets. ATNI recommends regular in-country analysis to identify and target consumers who are affected by socioeconomic inequities and COVID-19-related disparities. Action to ensure the accessibility of healthy food to these groups should be accompanied by an explanation of how the healthiness of products is based on objective nutrition criteria that align with international standards.

Category D: Marketing
ATNI recommends that global food and beverage manufacturers invest in improving marketing policies that accelerate efforts to drive sales of healthy options. Commitments should align with the ICC marketing framework, widen the media channels to which policies apply, and explicitly address in-store/point-of-sale and sponsorship marketing in policies.

Developing and delivering marketing strategies appropriate to priority populations is also key to overcoming the inequities that have been exacerbated by COVID-19. ATNI recommends all companies adopt and apply WHO regional standards on marketing to children, increase the age covered by restrictions to under-18, and lower the audience threshold used to restrict advertising on all media to 25% or less. Marketing restrictions in primary schools could be extended to include secondary schools, other places where children gather, and areas surrounding these places.

ATNI also recommends that companies commission independent, annual marketing audits of their responsible marketing policies.

Category E: Lifestyles
COVID-19 has shown that safeguarding the health and resilience of those working in the food supply chain is key to food security in times of crisis. Hence, ATNI recommends that companies urgently improve and extend their health and wellness programs, including both nutrition and physical-activity elements and setting meaningful and quantifiable outcomes. These programs should be accessible to all employees and their families globally, and with an additional commitment to improving the health and wellness of groups across the wider food value chain that are not direct employees.

ATNI recommends companies that have not yet done so develop robust and publicly-available parental policies that apply equally in market operations worldwide, including support for breastfeeding at work and providing parental support/paid maternity leave (ideally for at least six months).

Additionally, ATNI recommends that consumer education and healthy eating and active lifestyle initiatives are evidence-based, aligned with relevant national or international guidelines, and (co-)initiated and developed by independent organizations with relevant expertise. Companies could take renewed steps to support programs that address the specific needs of those at high risk of micronutrient deficiencies, particularly in the wake of the COVID-19 crisis.

Category F: Labeling
To compensate for differences in local regulations around the world, ATNI recommends that global food and beverage manufacturers commit to providing comprehensive nutrition information on all product labels, in all countries. This includes strengthening commitments to display BOP  nutritional information, including nutrients such as added sugars, fiber, and micronutrient content, and to provide interpretative FOP labeling.

ATNI also recommends companies commit to only using health and nutrition claims on products (including fortified foods) that are determined as being healthy by a relevant nutrient profiling system (NPS).

Category G: Engagement
The COVID-19 crisis has made clear the need for companies to take an active and constructive role in supporting government efforts to combat all forms of malnutrition, not only in their home countries, but in all markets in which they are active. ATNI recommends that global F&B  manufacturers publicly commit to lobby responsibly, in-line with the Responsible Lobbying Framework, explicitly support only evidence-based measures that are designed to improve health and nutrition, and comprehensively disclose the extent of lobbying carried out.

ATNI also recommends that companies engage with a wide range of national and international stakeholders with specific expertise in nutrition-related topics during the design of their nutrition strategies, programs, and interventions, to maximize positive impact on public health.

Marketing of breast-milk substitutes (BMS) and complementary foods (CF)
Forty years after the original International Code of Marketing of Breast-milk Substitutes (The Code) was adopted, the 2021 BMS marketing assessment provides clear evidence that the marketing practices of the world’s nine largest manufacturers of formula and foods for IYC are far from aligned with its recommendations.

ATNI encourages all of the nine major companies that make BMS and/or CF, which were assessed in the BMS/CF Marketing Index 2021, to adopt marketing policies that are fully aligned to the wording and scope of the 1981 Code, including all subsequent and relevant WHA resolutions.

ATNI recommends these marketing policies are applied to all product types. None of the six companies that have a BMS marketing policy extend this to all types of formula (i.e., none include growing-up milks for older infants from one to three years of age). Moreover, companies that make and market CF for children aged six months to three years of age need to incorporate the WHO guidance recommendations, issued in 2016 and associated with WHA 69.9. These are in relation to adhering to established standards and guidelines on CF product formulation, ensuring the appropriate use of marketing messages to support optimal feeding, avoidance of cross-promotions, and of conflicts of interest within the healthcare setting. It is critical that companies commit to uphold their policies in all markets (i.e., in both higher- and lower-risk countries) and apply them where there are no relevant regulations or where regulations do not fully implement The Code.

As for the companies that sell BMS products but do not yet have BMS marketing policies, ATNI encourages them also to publish such policies in which they commit to not only uphold relevant national regulations, but also implement The Code, in full, across all markets in which they operate currently or aspire to enter.

All companies are recommended to adopt effective, company-wide governance and management arrangements to ensure their policies are effectively and consistently implemented in all markets in which they operate, and to publish more information on their BMS and/or CF marketing policies and practices to provide greater transparency to all interest groups.

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Future Opportunities

ATNI embraces the evolution of the methodology in this iteration of the Global Index, including the incorporation of the assessment of the healthiness of companies’ product portfolios and the incorporation of policies and actions targeting priority populations at high risk of malnutrition, in both low- and high-income markets.

The COVID-19 crisis and its negative impact on malnutrition in the world has made it very clear, however, that more efforts at a faster pace are needed by the food industry to achieve the end of malnutrition in all its forms in 2030.

ATNI will share and reflect on the outcomes of this Index with the companies assessed, and with ATNI’s investor signatories that engage with the companies, to discuss required follow-up action. The Index results will also be discussed with a wider group of interested parties in nutrition and food systems during various on-line events, to determine ways in which the industry response to malnutrition can and should be strengthened to ensure healthier diets for all.

Moreover, ATNI is engaged in various working groups that are preparing for the United Nations Food Systems Summit (September) and for the Nutrition for Growth Summit (December). ATNI will disseminate the latest Index findings in these forums and share its experience on holding companies to account for their impact on nutrition. These events also provide all baby food companies with the ideal opportunity to make the commitments necessary to honor The Code.

The insights from the Index 2021 and the learnings from our 2020 COVID-19 project, in which F&B companies’ responses to the pandemic in relation to nutrition were monitored, will be used to identify areas in our Index methodologies and other accountability tools that require further development to amplify ATNI’s efforts to address malnutrition.

Category findings

The Corporate Profile assesses companies’ nutrition-related commitments and policies, practices and disclosure across seven categories. A product profiling exercise, assessing the healthiness of companies’ product portfolios using the Health Star Rating model is also part of the Corporate Profile.

Nutrition strategy
Nutrition management
Reporting quality
Product Profile
Product formulation
Defining healthy products
Product pricing
Product distribution
Marketing policy
Marketing to children
Auditing and compliance
Employee health
Breastfeeding support
Consumer health
Product labeling
Influencing policymakers
Stakeholder engagement
Did not provide information to ATNI

Nestlé and FrieslandCampina rank first and second in Category A respectively, with the most comprehensive nutrition strategies, management systems, and reporting among the companies assessed. Since the Global Index 2018, where 22 of the current 25 companies were assessed, Kraft Heinz shows the most significant improvement after adopting global nutrition guidelines in 2020, and increased their score from 0.5 to 3.4. In terms of ranking, Grupo Bimbo shows the biggest improvement in this category, going up seven positions to rank in 5th place and moving from a score of 4.9 (2018) to a score of 6.4 (2021). This is partly due to the way the company includes nutrition challenges in its risk assessments and acquisition decisions, and because Grupo Bimbo’s nutrition strategy is supported by its board and regularly audited.

Danone leads Category B, followed by Nestlé and FrieslandCampina. Besides their relatively high scores in the Product Profile, these companies have adopted nutrient profiling models to guide their (re)formulation strategies and have defined relevant targets for most nutrients of public health interest.

Product Profile

The Product Profile is an objective assessment of the nutritional quality of the packaged foods and beverage market.

FrieslandCampina and Nestlé rank first and second in Category C respectively, with the most comprehensive pricing and distribution approach for their ‘healthy’ products, including those products that are designed to address micronutrient deficiencies in groups experiencing and at high-risk of malnutrition. They are followed by Danone (third) and Unilever (fourth). Companies that show improvement in their scores are FrieslandCampina, Coca-Cola, Meiji, Mars, and Unilever. FrieslandCampina shows the greatest improvement in score (5.2 to 7.7), followed by Meiji (0.6 to 1.7).

FrieslandCampina ranks first in marketing with a score of 7.9. Reasons for the company’s lead position are its consistently high scores in each criterion and its commitments and efforts to address nutrition challenges for priority populations. Mars and Nestlé come in second and third with scores above seven, reflecting advanced strategies in protecting consumers, including children, from irresponsible marketing. Arla has improved its ranking the most, by five places, due to improvements such as joining the EU pledge on advertising to children and initiating internal auditing for general audiences. Conagra has decreased its ranking position the most, by seven places. This was not due to a significant drop in Conagra’s score, but rather increases in scores of other companies.

Unilever ranks first, followed by Nestlé. These companies have adopted a range of policies to support employee/consumer wellness and are involving some of their partners and suppliers throughout the value chain. Since the Global Index 2018, where 22 of the current 25 companies were assessed, Ferrero and Arla have shown the largest improvement which, in large part, can be attributed to improved commitments to support breastfeeding mothers in the workplace.

Unilever takes first place in the rankings with an improved score of 8.5, rising three places since 2018. It is followed by Nestlé (8.4) and Mondelez (7.0) in second and third positions. Arla (increasing from 2.5 to 6.2) and PepsiCo (increasing from 2.6 to 6.1) show the most improvement in their ranks.

Nestlé leads this category with a strong, well-structured approach to stakeholder engagement to gather feedback on its nutrition-related strategies and programs. FrieslandCampina and Unilever follow closely behind with strong commitments to, and examples of, supporting governments’ efforts to address malnutrition, while also showing evidence of engaging with a wide range of stakeholders in developing their nutrition strategies, policies, and programs.

BMS/CF marketing

Manufacturers of breast-milk substitutes (BMS) and complementary foods (CF) have a significant impact on infant and young child (IYC) nutrition globally, which not only have direct health impact on IYC but ultimately also affect the health of the future generation. The International Code of Marketing of Breast-milk Substitutes and all subsequent relevant WHA resolutions, including the guidance associated with WHA resolution 69.9 (collectively referred to as The Code), therefore urges and guides BMS and CF manufacturers to market their products responsibly to protect and promote exclusive breastfeeding in the first six months and continued breastfeeding up to two years of age and beyond. Although some progress has been made over the years, the leading BMS and CF manufacturers continue to fall short in fully abiding by the provisions of The Code in their corporate commitments and actions and therefore inappropriate marketing practices continue to pose a threat on global health.

Amplifying impact

Companies urgently need to deliver on the Sustainable Development goals:

Impact Goal Icon

End hunger, achieve
food security and
improved nutrition

Impact Goal Icon

Ensure healthy
lives and promote
well-being for all

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