Food & Beverage

For public health advocates, the Rio+20 environmental summit last week was an important opportunity to connect better health with sustainability.  The government negotiators from 188 nations and the thousands of activists from around the world who attended the three-day meeting went home with mixed reviews of their success in moving towards “the future we want,” the conference slogan.

The Director-General of the World Health Organization (WHO), Dr. Margaret Chan, called Rio+20 a “victory for health” and said of the final report: “This focus on the links between health and sustainable development is critical. Healthy people are better able to learn, be productive and contribute to their communities. At the same time, a healthy environment is a prerequisite for good health.”  Chan also released a new WHO report, Our Planet, Our Health, Our Future. Human Health and the Rio Conventions: Biological Diversity, Climate Change and Desertification, that describes the links between health and sustainable development. Many nations made commitments for future action or financial support. For instance, the United States agreed to partner with more than 400 companies, including Wal-Mart, Coca-Cola and Unilever, to support their efforts to eliminate deforestation from their supply chains by 2020.

On a more negative note, Greenpeace executive director, Kumi Naidoo, said that, “Rio+20 has been a failure of epic proportions. We must now work together to form a movement to tackle the equity, ecology and economic crises being forced on our children. The only outcome of this summit is justifiable anger, an anger that we must turn into creative, thoughtful and meaningful action.” A coalition of NGOs wrote of their opposition to the final agreement, “The Future We Want is not to be found in the document that bears this name. The Future We Want is not what resulted from the Rio +20 negotiation process. The future that we want has commitment and action, not just promises. It has the urgency needed to reverse the social, environmental and economic crisis, not postpone it. It has cooperation and is in tune with civil society and its aspirations, and not just the comfortable position of governments.”

In my post on Rio+20 last week, I wrote that creating a healthier, more sustainable future will require a willingness to reconsider the role of multinational corporations in today’s world. At first read, the final summit document The Future We Want didn’t provide much hope on this front.  It did, however, address non-communicable diseases directly, an improvement over earlier drafts. 

The report acknowledges “the global burden and threat of non-communicable diseases (NCDs) constitutes one of the major challenges for sustainable development in the twenty-first century.” And, according to the NCD Alliance, a global coalition of NGOs concerned about non-communicable diseases, the report:

• committed  to strengthen health systems toward the provision of equitable, universal coverage and promote affordable access to prevention, treatment, care and support related to NCDs,
• committed to establish or strengthen multi-sectoral national policies for the prevention and control of non-communicable diseases, and
• reaffirmed the right to use TRIPS (trade-related intellectual property rights) flexibilities to protect public health and promote access to medicines for all, and encourage the provision of assistance to developing countries.

But while the 53 page report used the words “health” or “healthy” 54 times, it used the term “business” only eight times and the words “corporation” or “corporate” only twice. When business was mentioned, it was described as one more partner in global alliances for sustainability. Yet as I noted last week, the Third World Network, an NGO in Malaysia, said in their Rio+20 briefing paper, “If governments want to enable sustainable development, then they must regulate transnational corporations who are drivers of unsustainable development.” As at so many global conferences, multinational corporations remained largely invisible in Rio, immune from the scrutiny needed to reform their unsustainable and unhealthy practices.

One way that environmental and public health activists can move from speeches into action is to identify the specific ways that corporations undermine the environment and health. A good place to start might be to focus on the role of Big Agriculture and Big Food in contributing to human induced climate change and the rise of NCDs.  In a new series on Big Food and Health PLoS Medicine is publishing several articles that outline the health side of the challenge. An introductory editorial notes that “big multinational food companies control what people everywhere eat, resulting in a stark and sick irony: one billion people on the planet are hungry while two billion are obese or overweight.” A recent article in Lancet describes some of the environmental consequences of Big Agricultural practices and a recent report by Deutsche Bank estimates that agriculture accounts for 25 percent of greenhouse gases. What might be the common goals that could bring activists in these two sectors together?  Here are some suggestions for starting points:

1.  Support global, national and local efforts that nurture smaller scale agriculture, subsidize fruit and vegetable production, and reduce meat consumption. 

2.  Restrict advertising and promotion of unhealthy products such as fast food, sugar-sweetened beverages and processed snacks.

3.  Challenge companies that use philanthropic support of environmentalism and sustainability (e.g., Pepsi, Coke and Dr. Pepper, as described in one of the PLoS Big Food articles) to achieve “innocence by association” and to divert attention from their other harmful practices.

4.  Protect science and universities from corporate penetration and establish standards of integrity that prevent corporations from using science and scientists to defend their harmful practices and deliberately create doubt to thwart public health policy. (For a useful description, see the Union of Concerned Scientists report  Smoke, Mirrors & Hot Air.)

5. Affirm the precautionary principal (that requires products or corporate practices to be demonstrated to be safe before widespread dissemination) as a way of protecting public health and the environment.

6. Strengthen agricultural and food trade agreements to protect health and the environment.

Already environmental and public health activists around the world are working on each of these goals.  By developing a global common agenda and bringing together activists, scientists, local and national governments and local, national and global NGOs, we can begin to create the world we want for our children and grandchildren. 

 

Image Credits:

1. JorgeBRAZIL via Flickr.

2. World Resources via Flickr.

Last week, the World Health Assembly, the governing body of the World Health Organization, voted in Geneva to adopt a new global target of a 25% reduction in premature mortality from noncommunicable diseases such as cardiovascular disease, cancer, diabetes and chronic respiratory diseases by 2025. All governments will now be obliged to collect data on diabetes and NCD deaths, and report regularly on progress to the United Nations. According to WHO officials, this mandatory target has the potential to drive significant action on heart disease, diabetes, cancer and chronic lung disease across all countries.

Timothy Armstrong, coordinator of Surveillance and Population-based Prevention in the Department of Chronic Diseases and Health Promotion at the WHO, said, “This is a landmark decision on the prevention and control of NCDs. For the first time, we are moving away from aspirational goals to an action-based approach that will be anchored in quantifiable targets.”

Representatives of non-governmental organizations (NGOs) also celebrated this new resolution. Ann Keeling, Chair of the NCD Alliance and CEO of the International Diabetes Federation declared: “The adoption of this bold and ambitious target is a landmark event in the fight against NCDs. For the first time all governments will be accountable for progress on NCDs. The NCD Alliance and its members and partners around the world have worked tirelessly for nearly a year for this. On behalf of the hundreds of millions of people with NCDs, we are delighted to see this result.”

While the vote is a step forward – at the UN High Level Meeting on NCDs in New York City last September, governments concerned about austerity and fiscal constraints and representatives of the food, tobacco, alcohol and pharmaceutical industries worried about threats to profits from a determined global campaign to prevent NCDs joined forces to delay any specific targets for reductions in NCD deaths.

Several daunting challenges face effective action to prevent premature deaths and avoidable illnesses from NCDs. Currently, the provisions of trade agreements negotiated through the World Trade Organization or bilateral or multilateral agreements among nations often preclude the effective regulation of the tobacco, alcohol and food industries that have played a prominent role in creating the current burden of NCDs.  Ron Labonte and his colleagues explain these relationships in a recent report on international trade and chronic disease.    

In addition, these agreements protect the intellectual property rights of pharmaceutical companies, making it more difficult for emerging and low income nations to produce and distribute at affordable prices the medications that can help prevent complications from heart disease, cancer or diabetes. As a public health commentator in Australia asked about last week’s agreement, “Will World Trade Organization (WTO), World Bank and International Monetary Fund (IMF) policies help or exacerbate the problem?” In the past, these organizations have often promoted corporate-managed trade at the expense of public health protection. Another obstacle to effective action is the determined efforts by multinational corporations to avoid public health oversight. In the United States and the United Kingdom, two countries with a long history of public regulation, the food and beverage industries have recently launched mostly successful campaigns to thwart stronger regulation of the products most associated with diet-related chronic conditions. If the governments of two of the wealthiest nations are unable to stand up to special interests, what are the chances for many poorer nations?

In addition, new worries about economic growth in India and China, two countries with the largest number of people predicted to come down with NCDs in coming decades, may limit resources for public health prevention and further tilt these governments to adopt pro-market policies that contribute to NCDs.  As I noted in an earlier post, Coke, Pepsi and fast food companies have targeted China as their next growth area, ensuring a new generation of people with diet-related chronic diseases. 

Some have also questioned whether the UN has the backbone or muscle to stand up to special interest.  WHO is itself going through a complex re-organization, distracting top officials at least to some extent.  Some critics have also warned about the growing dependence of WHO on corporate and philanthropic funding, trends which might compromise its ability to speak clearly for health.

The resolution on NCDs passed by the UN General Assembly in September 2012 requires countries to develop and report back to the UN their national NCD plans in 2014. What can public health professionals do to ensure progress by that date?

One concrete starting place is the Rio plus 20 United Nations Conference on Sustainable Development to be held in Rio de Janiero on June 20-22.  At this meeting and in its aftermath, activists and governments can strengthen the ties between organizations and constituencies concerned about sustainable development and those concerned about NCDs.  Solutions to each require charting a new path that ends the promotion of patterns of consumption that threaten the planet’s future and create new epidemics of NCDs.  Charting policies that discourage the corporate promotion of unhealthy and unsustainable lifestyles and strengthening the capacity of governments and international organizations to act to protect public health and the environment are the broader goals of such an alliance.  Such an agenda can begin to catalyze the movements that will have the passion and power to suggest that another road to human development is possible.

Different nations have the potential to play different roles in creating a new ethic of healthy and sustainable consumption.  The wealthiest nations in North America and Europe can find new ways to re-create past successes in public health protection and apply them to the twenty first century challenges of growing inequality, persistent poverty and unsustainable consumption.  Emerging nations like China, India, Brazil and South Africa can experiment with new approaches to bringing the benefits of prosperity to large sectors of their populations without imposing on them the burden of premature mortality, preventable illness and unaffordable  health care costs now observed in many Western nations.   Finally, the poorest nations have the most to gain by continuing progress in reducing infectious diseases without going down the road that will bring them to high levels of NCDs.  All nations will encounter the determined resistance from  the multinational corporations that continue to profit from current patterns of NCDs.  Finding new ways to confront that force will determine whether counting NCDs, as now required by the World Health Assembly, can be a first step towards preventing them.

 

Image Credits:

1. UN Radio and Media

2. Dave Proffer via Flickr