27th April, 2011
WHO Global Forum in Moscow. Tackling food-related diseases: voluntary measures or regulation – carrot or stick?
The World Health Organization’s global forum in Moscow on 27th April, Addressing the challenge of noncommunicable diseases, sparked concern from public health campaigners and Member States about the potential for food industry influence on WHO and governments’ strategies to curb food-related diseases.
The meeting was part of a global effort to raise the profile of non-communicable diseases such as heart disease, diabetes, stroke, lung cancer and chronic respiratory disease – diseases which account for 63 percent of deaths worldwide — 70 percent in the United States and 90 percent in Russia.
Describing the importance of the NCD problem, Dr Margaret Chan, WHO’s Director General identified the harm being caused by the promotion of tobacco and unhealthy foods: “For some countries it is no exaggeration to describe the situation as an impending disaster. I mean a disaster for health, for society, and most of all for national economies….Today, many of the threats to health that contribute to noncommunicable diseases come from corporations that are big, rich and powerful, driven by commercial interests, and far less friendly to health….Here is a question I would like to ask the food and beverage industries. Does it really serve your interests to produce, market, globally distribute, and aggressively advertise, especially to children, products that damage the health of your customers? Does this make sense in any mission statement with a social purpose?… I strongly believe that the rise of chronic diseases calls for some serious thinking about what the world really means by progress. What is the net gain if the benefits of modernization and economic growth are cancelled out by the costs, like medical bills, lost productivity, and premature death, of a preventable disease? Unless they wake up, and take a hard look at policies across-the-board, some countries may very well see that the benefits of economic progress are quite literally cut up and devoured by a knife and a fork. (1)
WHO’s call for urgent action was strongly supported by IBFAN and all who attended the meetings including Prime Minister Vladimir Putin who attended on the 28th. The Recommendations from the Forum and the subsequent Ministerial meeting on the 28th and 29th will go forward to the World Health Assembly in May and then to the UN High level meeting in New York in September.
Of concern however, was the fact that for the “Global Forum” on the first day – WHO’s usual protocol and procedures was not used and representatives from corporations which represent a conflict of interest, such as PepsiCo, Coca Cola, Nestlé and the World Federation of Advertisers, attended in their own capacity or as part as of a new group called the International Food and Beverage Alliance (IFBA), rather than as bodies in official relations with WHO. (2) Tobacco companies were the only industry deemed to be beyond the pale. in the working group on food and drink, chaired by Jorge Casimiro of Coca Cola, Janet Voute of Nestlé presented IFBA’s voluntary, self-regulated proposals to reformulate foods, extend ‘responsible advertising’ and support public private partnerships. With no non-profit NGOs speakers and a rapporteur from the Public Private Partnership, Global Health Council, it was left to Member States and health NGOs in the audience to point out the weaknesses and loopholes of the proposals and to suggest more effective strategies such as controlling junk food marketing and reformulation with legislation.
Sirpa Sarlio-Lahteenkorva, an official in the Finnish Health Ministry explained that Finland tried to reduce the amount of salt in food by seeking voluntary commitments from manufacturers, with mild success. But when the Government required salt labeling, consumption dropped sharply, she said. The same happened when the Government increased taxes on alcohol. (Finland is the world leader in reducing deaths from non-communicable disease.) (3)
Patti Rundall, OBE, Policy Director of Baby Milk Action and the UK member the International Baby Food Action Network (IBFAN) raised concerns about the message that could be conveyed to Member States and recalled WHO’s mandate to protect health for all and its responsibility to advocate changes that are ‘fit for purpose.’ Since industry can and does already make representations at each World Health Assembly, is there really a need to give industry greater opportunities to influence policies? Before making any fundamental changes WHO is being asked to:
- implement strong and clear ground rules to protect its role and independence and prevent undue corporate influence on WHO’s health policy setting process;
- to provide guidance on how to minimise and determine what is and is not an acceptable conflict of interest.
In her closing remarks at the end of Wednesday’s Forum, and in response to Ms Rundall’s remarks, Dr Chan reassured the meeting that she was not intending to change WHO’s constitution and that Member States would always make the final policy decisions. But fears about WHO’s independence remained as a result of the repeated calls for an increase in the role of the private sector and the possibility of funding from them. Dr Chan qualified her call to ‘trust’ the industry and work with them, with a demand that they deserve that trust and ‘walk the talk’ – ie not overdo their promises. But she fell short of explaining where the hard evidence would in future be found to validate their promises or whether partnerships would undermine NGOs independent watchdog role. IBFAN has ample evidence of how easily companies can give the illusion of compliance with WHA Resolutions on infant food marketing. (3) In her final remarks Dr Chan stressed the importance of breastfeeding and the first 1,000 days of life.
Member States will debate this issue again at the World Health Assembly in Geneva in May and it remains to be seen whether an amendment to the draft Resolution on NCDs proposed by India and Bangladesh will be retained: “to implement the WHO action plan for the global strategy for the prevention and control of noncommunicable diseases, and to seek the active engagement and support of all relevant non-health sectors, while adhering to principles relating to avoidance of conflicts of interest” (4)
Commenting Patti Rundall said: “Member States have to decide whether the industry’s voluntary strategies are the right way to go. They can be alluring because they are so easy and can sound marvellous. But the lack of impact and loopholes often become evident only when they are examined and monitored carefully by a totally independent body. Rarely does industry accept such findings, preferring self or third-party monitoring where it can influence the criteria and conclusions. IBFAN has monitored the baby food industry for the last 30 years, using World Health Assembly resolutions as benchmarks rather than industry’s weaker policies. We have used this evidence to help governments bring Resolutions into law in over 60 countries, forcing companies to end the promotion which does so much to mislead parents and undermine infant and young child health. If voluntary measures are promoted as the solution to NCDs Member States may lose the will to legislate and tackle the problems effectively. Health services and families will pick up the costs.” (5)
In his summing up of one of Wednesday’s working groups, Prof David Matthews, Director of the Global Alliance for Chronic Diseases (a collaboration of six worldwide national Medical Research organisations) stressed the expense of the chronic diseases: “Years and years of diabetes, obesity and cardiovascular diseases are extremely expensive for health services.”
Commenting on the meeting, Prof. Philip James, President of the International Association for the Study of Obesity (IASO) said: “The current focus on non-communicable diseases is very welcome but few Ministries of Health seem to realise that the real determinants are often far removed from the health sector and are fundamentally tied in to business practices and current governmental policies. So far there is little mention of either the importance of the first 1000 days of life or the key factors – other than smoking and salt intake – which actually cause the problem!”
1 WHO’s Global Status Report on Non-communicable disease, shows that 63% of global deaths (36 million) in 2008 were caused by cardiovascular disease, diabetes, chronic respiratory disease, and cancer. Four fifths of the deaths were in low and middle income countries, and 29% of the deaths in low and middle income countries were in those under 60 compared with 13% in high income countries. The report shows that NCDs are caused by tobacco (6 million deaths annually), physical inactivity (3.2 million deaths), harmful use of alcohol (2.3 million deaths), unhealthy diet, raised blood pressure (7.5 million deaths), and obesity and overweight (2.8 million deaths). Underlying these causes are social determinants like modernisation, globalisation, and urbanisation.
Moderated report back session http://who.telemarker.ru/148.html http://who.telemarker.ru/
Closing remarks by Dr Margaret Chan http://who.telemarker.ru/239.html
2 Ten companies are members of the International Food and Beverage Alliance (IFBA)
3 WHO takes on Chronic Disease, Will Englund, 28th April 2011, Washington Post
3 Nestlé needs to stop violating baby milk Code says new board member, Veneman, ex UNICEF Director http://info.babymilkaction.org/pressrelease/pressrelease15apr111
IBFAN’s Monitoring report: “Breaking the Rules, Stretching the Rules 2010” http://www.ibfan.org/news-2010-1224.html
4 Prevention and control of noncommunicable diseases WHO’s role in the preparation, implementation and follow-up to the high-level meeting of the United Nations General Assembly on the prevention and control of noncommunicable diseases (September 2011) Amended draft resolution reflecting the work of the informal drafting group convened during the 128th session of the Executive Board and incorporating proposed amendments from Member States received by mid-February 2011 http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_21-en.pdf
5 s a member of the EU Commission’s Platform for Action on Diet, Physical Activity and Health, IBFAN has seen how benchmarks and objectives can be lowered when industry is around the table. The Platform is an multi-stakeholder experiment set up by the European Commission in 2005 to see if self-monitored voluntary commitments could be effective in curbing the rise obesity on food related illnesses with the promise that if it did not deliver, regulations to control marketing would be considered. Six years since its inception there is no tangible impact on obesity levels and no evidence that voluntary commitments are more effective than regulation. Many of the commitments made by industry focus on education which can present an even greater problem than straightforward advertising. Tackling Obesity: How Companies Use Education to Build Trust.http://info.babymilkaction.org/node/412.)
Corinna Hawkes1,* and Jennifer L Harris Public Health Nutrition