The recent World Health Assembly (WHA), one of the World Health Organisation’s (WHO) governing bodies, held several discussions on non-communicable diseases (NCDs). This included obesity, with the WHO declaring most countries to be off track in reaching three of the targets set for 2030: halting the rise in obesity in children, adolescents, and adults, ending all forms of malnutrition, and bringing the prevalence of young children with obesity under 3%.
In 2019, obesity accounted for almost one-sixth of all deaths from NCDs, according to the WHO. While there are some genetic and biological determinants to obesity, the main cause for the high prevalence the world is seeing is the so-called obesogenic environment. This describes the social, commercial and political circumstances that contribute to individuals’ insufficient physical activity and energy-dense food intake and, in combination, lead to obesity.
Addressing the obesogenic environment
The fact that obesity is a modifiable risk factor in the NCDs epidemic should call society and public health professionals to action. The market for processed foods and sugary beverages is growing, and products are being pervasively marketed to people who end up with harmful intake of sodium, sugar, and saturated fats. The effects are particularly felt among workers, whose workloads leave little time for food preparation and, combined with a low income, push them towards consumption of packaged food with high energy and low nutritional value.
Transnational corporations are reaping in profits and target vulnerable populations such as children, especially from lower socio-economic backgrounds, fueling health – or rather disease – inequity. In 2020, food and beverage industries spent over $30 billion on marketing alone, compared to the WHO’s budget of around $6 billion over two years. The commodification of food and beverages leads to the destruction of traditional nutrition and agriculture, and makes fresh, unprocessed foods and clean water less accessible, especially in poor communities.
WHO and many governments have already acknowledged the need to regulate food and beverage marketing, increase taxation on processed foods and sugary beverages, and make the nutritional value of products more transparent through front-of-pack-labeling. Yet, a more serious implementation of these policies is being undermined by the multi-stakeholder approach, which is letting industries influence the conversation.
The industry’s conflict of interest must be taken much more seriously by the WHO and its members in order to prioritize the health of the people. There is strong evidence on the effectiveness of policies such as taxation of sugary beverages, restricting marketing which targets children, and nutrient labeling. This stands in contrast to programs which focus on the individual and “making healthy choices”, which transfer the responsibility for ill health to people living with obesity, rather than standing up to structural commercialization and power.
Finding an implementable strategy against obesity
Social determinants of health were frequently mentioned by countries from all regions during the WHA, with some, such as Mexico and Norway, calling for a clear limitation of industry influence through a framework similar to the Framework Convention on Tobacco Control (FCTC). The delegate of the Bahamas criticized the fact that obesogenic environments are allowed to proliferate unchecked and called for normative standards for the food manufacturing industry as well as for nutritional labeling. The United States delegation, however, reminded the WHO to stay within its mandate. This hints towards a US policy which reprimands the WHO for touching upon trade-related topics and frequently puts the World Trade Organization’s (WTO) work before the WHO’s and thus, often puts profits over health.
For example, the delegation urged the WHO not to interfere with the Codex Alimentarius, an international food and nutrition framework by the FAO and the WHO. The Codex is known for siding with high-income countries’ and industries’ interests. In this context, Thailand’s delegate stressed the need for effective regulation of marketing of breastmilk substitutes in the face of new marketing strategies that target mothers and pose a risk for obesity in young children. If the WHO does not address more practical aspects of regulation, the documents that come out of this discussion “will just be another piece of paper without implementation,” the delegate warned.
An acceleration plan for preventing obesity was noted at the Assembly. Yet, while the plan addressed the need to tackle obesogenic environments through taxation, fiscal policies, marketing restrictions and nutritional labeling, concrete implementation guidelines are missing. The plan also calls for “non-State actors , i.e. nongovernmental organizations, private sector entities (including international business associations)” to join the efforts of the acceleration plan. This should be a cause for concern, as such an approach openly invites the industry to join the process of policy-making, when the WHO should actually enable a process protected from conflict of interest.
At the same time, the structural factors leading to obesity are being increasingly recognized in some of the WHO’s regions. Henri P. Kluge, the regional director of WHO Europe, addressed delegates with remarks based on a newly released regional report on obesity. The report encompasses fierce analysis of structural problems, including “neoliberal and capitalist ideology”. Kluge’s remarks however fell short on the report: while he pointed out the need to implement evidence-based policy such as taxation of sugar-sweetened beverages and marketing restrictions, he also invited all stakeholders, and explicitly the private sector, to join forces in developing an accountability framework.
On the other hand, officials from Mexico, Chile, the Philippines and the Seychelles reflected on their experiences of effective regulation and front-of-package-labeling while outlining the importance of political commitment to act on the upstream determinants of obesity during a side event. As an example, Mexico’s Vice-Minister of Health, Dr. Hugo Lopez-Gatell, pointed out how structural adjustment programs and trade liberalization lead to a massive increase in obesity in the country.
Obesity was touched upon during several other discussions at the Assembly. Following Dr. Tedros Ghebreyesus’ re-election as Director-General of the WHO, the Assembly adopted a resolution on “Well being and health promotion”. Brought to the stage by 13 countries, including the US and the United Arab Emirates, the resolution urged the WHO to develop a framework which promotes healthy environments. It cites a multi-sectoral approach and numerous social determinants of health including the need for “healthy food from sustainable food systems”. At the same time, the Assembly’s discussion on food safety continued to evolve around a securitized approach of preventing transmission of food-borne infectious diseases, while glancing over the impact that unhealthy foods are having on non-communicable diseases such as obesity.
Although there are signs of a growing consciousness at the WHO and at the national level on the need to tackle structural environmental determinants of health, including the quality and availability of healthy foods, there remains much room for advancement. Civil society will need to keep the pressure on to ensure action which will tackle the prevailing political economy of food. To promote healthy diets, legally binding regulation as well as building a healthier environment will be necessary to uphold the highest possible standard of health. Sustainable and local food production must be promoted through subsidies and protection of markets from cheaply imported processed foods. This must encompass biodiversity and sustainable agriculture to create a food system which keeps its recipients, its workers, as well as animals and the planet healthy – free from adverse interest.
The WHO Watch team members are Abhishek Royal, Alan Rossi Silva, Aletha Wallace, Anton Sundberg, Ben Verboom, Dian Maria Blandina, Jasper Thys, Maria Alejandra Rojas, Marta Caminiti, Sarai Keestra, Sopo Japaridze, Lauren Paremoer, Jyotsna Singh, and Gargeya Telakapalli.
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