“Non-communicable diseases have emerged as a growing health problem for countries of every size, in every corner of the globe, at every stage of development”
Thus said Kathleen Sebelius, the secretary of the U.S. Department of Health and Human Services, at a panel luncheon in September. The standing-room-only event was held during the UN General Assembly debate, which opened with a high-level meeting on NCDs. The panel also featured Margaret A. Hamburg, commissioner of the U.S. Food and Drug Administration; Despina Spanou, principal adviser to the director-general for health and consumers, European Commission; Julio Frenk, a dean at the Harvard School of Public Health; and Derek Yach, senior vice president of global health and agriculture at PepsiCo. Charlotte Howard, a healthcare correspondent for The Economist, moderated. The program was presented by the International Food and Beverage Alliance and the Business Council for the UN, in collaboration with the UN Foundation.
Reiterating that fighting chronic diseases – heart, stroke, diabetes, cancer and other illnesses – is not the “responsibility of the food and beverage industry alone,” Sebelius said that work must continue to “reduce the risk factors that contribute to chronic disease” with partners. Sebelius said that increasing consumer awareness is one way to improve eating habits, like menu labeling. She was questioned on voluntary approaches by the food and beverage industry to making more healthful products versus regulatory targets. Noting that “some significant progress has been made in voluntary fashion,” the food industry nevertheless wants everyone in the business to comply, so that creating standards might well be the best route, she said.
Margaret Hamburg of the FDA reminded the audience that NCDs are a result of social, behavioral and lifestyle issues that her agency plays a role in – providing leadership in consumer education, awareness and access to information about food products and “healthy choices.” She said that progress has been made by the industry in sodium reduction and trans fat decreases in foods, but that the FDA’s most important job is to “help provide the best possible information and help to make sure new knowledge is generated” and to apply that knowledge to what is being done. “We need to really deepen the base of scientific research” on product safety and formulation, she added. What is the usefulness of sodium in baking, for example, and consumer preferences? Such research can be done with industry, academia and government working together, Hamburg said.
Despina Spanou of the European Commission offered a Euro-centric element to the topic of NCDs, where 15 percent of the population is obese, an increasing trend in that region. One of four deaths of young men in the European Union is alcohol-related. Up to 650,000 deaths stemmed from tobacco use; while a quarter of adults surveyed said they did not exercise. “Partnerships for us are very important,” Spanou said, citing the 27 members of the EU and how they must work together on this health problem. Salt reduction is “ahead of the game” in Europe, she said, because it was one of the first areas the governments started working on in reformulations. All countries in the EU have agreed to a common target of 16 percent reduction in the next four years, an achievement done without legislation. Best practices on nutrition and diet are also exchanged through the 27 countries, while France took the first step in the group to regulate labeling on its wine products warning pregnant women of the danger of alcohol on fetuses. Spanou cited the need to work with all sorts of stakeholders, including civil society, families, schools, universities, consumer groups, retailers, doctors, international organizations and more.
Julio Frenk of Harvard noted that discussing NCDs at the UN in New York rather than at the UN in Geneva was a significant step in raising the profile of this health problem, “expanding the circle of the conversation” and moving beyond the “dichotomies of poor and rich countries” in the arena of communicable and non-communicable diseases. “The situation has become much more complex. Most countries are facing a double burden of disease. As we’re talking about all our concerns about obesity and overweight, there’s still a billion people who are undernourished in this world.” Frenk noted that three major pillars are fundamental to creating a healthier world: a new generation of health promotion, risk protection and disease prevention strategies and policies; universal access to high-quality service with financial protection; and innovations in the delivery of services that mobilize the current revolutions in telecommunications. “This is a global problem, we need global policy instruments,” he concluded. “We need to create global standards and global forms of money flowing from mutual accountability.” Derek Yach of PepsiCo finished the panel discussion by touching on the progress of, among other efforts, reducing sodium in food products by working with the World Health Organization and others. PepsiCo, he said, looked carefully at best examples of salt reduction – in the UK, Finland and Japan, noting that the work was done incrementally and voluntarily. Citing the particulars of such tough steps, Dr. Yach recalled a meeting where British Stilton cheese makers talked about how they would lower sodium in their products but that French Roquefort cheese imported to the UK would have higher levels.
The food industry, he said, has made “profound change” in many developing countries. Frito-Lay, for one, started to cut trans fats a decade ago, eventually using sunflower oils to do so. But the challenge is multilayered, he added. “The reality we face across the world is that the pricing is against making that shift an easy shift. Unless we are willing to accept that the trans fat issue and the move to healthier oils cannot be undertaken by the foods sector without the deep engagement of the agricultural sector, I think we’ll fail to make the progress we want to make.” One success, he said, was working in Mexico with the agricultural ministry and the InterDevelopment Bank to encourage farmers to produce sunflower oil instead of palm oil. Asked about regulation, Yach said there will always be a place for setting enabling goals and targets, but that self-regulation is a more effective way of achieving desired public health goals.
Kimberly Goldstein, of KPMG’s international development assistance services unit, after the event offered “The discussion around the necessity of partnership between the public and private sectors, and the recognition by health and human services leaders that NCDs are also a critical issue in the developing world inspired a sense of hope. It is only by innovative collaboration between private and public sector actors, with a comprehensive work view, that this issue will receive the attention it deserves”. Written by Dulcie Leimbach. Produced by Darren de Freitas.