In this blog post, Remco van de Pas reflects on a recent WHO-Euro conference on nutrition and Non-Communicable Diseases (NCDs).
Last week, the WHO-Euro conference on nutrition and NCDs in the context of Health 2020 took place in Vienna. The purpose of this meeting was to identify policies for the prevention and control of diet-related NCDs. Within the European region there is a dramatic rise in childhood obesity and an increasing incidence of diet-related NCDs. The conference was attended by health ministers and national delegations. Some intergovernmental organizations and NGOs, including ourselves, were invited as observers.
Malnutrition (both under- and overnutrition) is a major risk factor for the high burden of NCDs worldwide, and Europe is no exception. Key presentations at the conference by João Breda, Philip James and Carlos Monteiro indicated very clearly the problem. In 2010 1 in every 3 children aged 6-9 was obese or overweight in the European region (coming from 1 in 4 in 2008). The prevalence of overweight and obesity among the adult population is now over 50% and 15% respectively, in a majority of the European countries. Moreover, this prevalence is expected to grow, see the figure below.
Limited breastfeeding practices, childhood stunting (20-30% in some rural areas of Europe) and poor maternal nutritional status during pregnancy (20%) are also observed. A major reason for the rise in obesity is the increased consumption of trans-fatty acids, salt and sugar in ultra-processed ready-to-eat foods and soda. This has led to an increased energy intake per person/day (see the figure below). As Europeans on average have also become physically less active, the biological reaction of the human body is to “store” the extra energy, hence leading to overweight and obesity.
Within the public health and health policy community, there is now an intense debate going on about how to address this worrying trend. WHO’s DG Margaret Chan, put it like this in her forceful speech at the 8th global conference on health promotion, last month in Helsinki.
“Today, the tables are turned. Instead of diseases vanishing as living conditions improve, socioeconomic progress is actually creating the conditions that favor the rise of NCDs. Economic growth, modernization, and urbanization have opened wide the entry point for the spread of unhealthy lifestyles. The globalization of unhealthy lifestyles is by no means just a technical issue for public health. It is a political issue. It is a trade issue. And it is an issue for foreign affairs.
As the new publication makes clear, it is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. Market power readily translates into political power. Few governments prioritize health over big business. As we learned from experience with the tobacco industry, a powerful corporation can sell the public just about anything. When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely. In the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests.”
The conference in Vienna showed that some countries such as Denmark, France Austria and Hungary have taken regulatory measures to reduce trans-fatty acids in products. They also imposed taxes on soda and (some) ultra-processed foods. Most other countries rely on self-regulatory measures taken by the food industry, as well as a mix of multi-sectorial approaches such as healthy food subsidies for school canteens, promotion of physical activity, urban planning, supporting healthy choices and marketing restrictions for children of unhealthy food. During lunch sessions, the journalist Michael Moss provided insights from his book Salt, Sugar, Fat, while Eve Heyn of GBC Health, a global coalition of over 200 private sector companies working to improve global health, spoke of the role of the private sector. The NCD Free campaign was able to show their online campaign to the conference participants.
The 53 European region countries eventually agreed upon the Vienna declaration, which promotes decisive and urgent action by governments on the topics mentioned in this blog, while carefully avoiding language about the need to address the causes of the causes of diet-related NCDs.
We have interesting times ahead of us. In most of the countries, as well as at the EU and global level, there will be further research, policy dialogue, strong lobbying and heated political debate about the required policies, and whether or not to engage Big Food and Big Soda in these actions. What is relatively missing from the public health debate so far, is the dialogue with economic, agricultural, veterinary actors and food investors. How to safeguard public health in relation to these powerful interests?
Behind these questions lie deeper individual and societal choices. Do we really need all these different kinds of processed food and beverages, even if they are reformulated to contain less sugar, salt and fat? Do we really need to eat all these saturated fats and proteins from the intensified meat producing industry? Are local food products not available or affordable anymore? Do people still take time to prepare their own food?
Via continuous and clever marketing strategies, we have increasingly become hooked on this pattern of consumption in a 24-hour economy. For ourselves and our children it’s better that we detoxify ourselves, as this consumption pattern is not only unhealthy but also highly unsustainable. If not, we and the planet risk a cold turkey in the not too distant future.
PS: An excellent parallel twitter conference took place on the sidelines of the formal conference, and can be read in full via #NCDVienna . Gauden Galea from WHO Euro has provided an analysis of this twitter conference via his blog.
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