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I’ve just been sent a copy of  the opening address given by the Director-General of the World Health Organization, Dr Margaret Chan, to a Global Conference on Health Promotion in Helsinki on June 10.

Here is an excerpt from her extraordinary remarks:

Today, getting people to lead healthy lifestyles and adopt healthy behaviours faces opposition from forces that are not so friendly.  Not at all.

Efforts to prevent noncommunicable [chronic] diseases go against the business interests of powerful economic operators.

In my view, this is one of the biggest challenges facing health promotion…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.

Research has documented these tactics well. They include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt.

Tactics also include gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public.

They include arguments that place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice.

This is formidable opposition. Market power readily translates into political power…

Not one single country has managed to turn around its obesity epidemic in all age groups.  This is not a failure of individual will-power. This is a failure of political will to take on big business…

I am deeply concerned by two recent trends.

The first relates to trade agreements. Governments introducing measures to protect the health of their citizens are being taken to court, and challenged in litigation. This is dangerous.

The second is efforts by industry to shape the public health policies and strategies that affect their products. When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely. This, too, is well documented, and dangerous.

In the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests.

Dr. Chan was courageous to say this so clearly.  Would that our health officials would be as brave.

I was fascinated to read Michael Mudd’s piece in the New York Times on Sunday, “How to force ethics on the food industry.”  Noting that the court overturned Mayor Bloomberg’s 16-ounce soda ban, he said:

But governments should not be deterred by this and should step up their efforts to protect the public health by limiting the marketing tactics of food companies. Anyone who believes these interventions are uncalled-for doesn’t know the industry the way I do.

…The industry is guilty because it knew what the consequences of its actions might be. Large food processors employed a flock of Ph.D. nutritionists and food scientists. The connection between calorie consumption and weight gain was always as plain as the number on the bathroom scale. But instead of acknowledging this and taking corrective action to sell a better product more responsibly, food processors played innocent by blending in with the crowd of causes.

This sent me to dig through my files to search for what I’d saved about Mr. Mudd’s efforts at Kraft.  Here, for example, is the front page of USA Today, July 1, 2003.  Kraft chose USA Today to announce its new anti-obesity initiatives, and gave it an exclusive to do so.

The initiatives included, among a long list, elimination of all in-school marketing, setting nutritional criteria for marketing practices, and establishing meaningful criteria for health claims.

Even at the time, I was dubious:

They have to demonstrate what it is they’re actually doing before I can start turning cartwheels about this…Kraft has other credibility problems when it comes to marketing healthier products…Philip Morris Co., the tobacco giant now called Altria Group, owns 84 percent of Kraft [Altria sold off Kraft in 2007].

One year later, Kraft announced  that  it had begun to act on its promises.  After another six months, Kraft introduced its Sensible Solution  program  to label “better-for-you” products. leaving plenty to be dubious about.  By 2004, Michael Mudd was no longer with Kraft.

In 2007, I sent a couple of students out to see whether Kraft had kept its promises.  Not a chance, as we documented.

How come?  Food companies are not social service agencies.  Their job is to sell products.  And, as Michael Moss explains in Salt, Sugar, Fat, they must do whatever it takes to achieve that goal.

As Mr. Mudd now puts it,

It’s time to end the charade and mandate the needed changes that the industry has refused to make. 

The Lancet has just published a series of articles on non-communicable diseases (NCDs) the collective term for heart disease, type 2 diabetes, and other chronic conditions caused in large part by poor diets, lack of physical activity, or cigarettes or alcohol.

Since food politics is a big part of this discussion, these papers are worth a look.  For example, as editor Richard Horton explains in his editorial:

If I were teaching public health nutrition right now, here’s what I’d want students to read:

Geof Rayner and Tim Lang, Ecological Public Health: Reshaping the Conditions for Good Health, Routledge Earthscan, 2012.

Our case is that public health is an interdisciplinary project, and not merely the preserve of particular professionals or titles.  Indeed, one of the themes of the book is that public health is often improved by movements and by people prepared to challenge conventional assumptions and the status quo…In these cynical academic times, when thinking is too often set within narrow economistic terms—What can we afford? What is the cost-benefit of health action?—and when the notion of the ‘public’ is often replaced by the ‘individual’ or the ‘private,’ this book offers an analysis of public health which is unashamedly pro bono publico, for the public good.

David Stuckler and Karen Siegel, eds.  Sick Societies: Responding to the Global Challenge of Chronic Disease, Oxford University Press, 2011.

Sick Societies argues that we are building environments that are poorly designed for our boides: we create societies where tobacco, alcohol, and foods containing high levels of salt, sugar, and fats are the easiest, cheapest, and most desirable choices, while fruits, vegetables, and exercise are the most expensive, inaccessible, and inconvenient options.  The rise in chronic diseases is the result of a model of societal development that is out of control: a model that puts wealth before health.

Wilma Waterlander, Put the Money Where the Mouth Is: The Feasibility and Effectiveness of Food Pricing Strategies to Stimulate Healthy Eating, Vrije Universiteit, Amsterdam, 2012.

This one is for policy wonks and change agents.  This is Waterlander’s doctoral dissertation done as a published book but it is written clearly and forcefully.  Her conclusions:

The studies presented in this thesis show that the healthy choice is the relatively expensive choice; that price fundamentally affects food choice and may even form a barrier for low SES consumers in selecting healthier foods.  These findings make pricing strategies a justifiable tool to stimulate healthier choices…making healthier foods cheaper was found to be the most feasible pricing strategy to implement.

Most of you probably don’t read the Journal of Public Health Policy, but I’m on its editorial committee.  Nevertheless, this editorial came as a surprise.*   I thought I would share it with you.  Enjoy!  (I did).

Big food

Anthony Robbins M.D., M.P.A., Co-Editor

I first encountered Marion Nestle in the late 1990s when I edited Public Health Reports, the scientific journal of the US Public Health Service. We published a provocative piece of hers about the marketing by Proctor and Gamble of Olestra, a zero calorie fat substitute. Marion taught me a great deal about how the food industry markets its products that are tasty, convenient, and relatively inexpensive. It markets intensively to children and continues to do so long after overeating and obesity have been shown to have deadly health consequences. Sound familiar? Perhaps like the tobacco industry.

In 2003, I invited Marion to Public Health Grand Rounds to describe the obesity epidemic to my public health students at Tufts Medical School. To follow Marion, I invited Richard Daynard from Northeastern Law School, who had litigated extensively against the tobacco industry. Dick carefully noted the differences between tobacco, which has no healthy use, and food. But he suggested that the anti-health behavior of the two industries might be similar: continuing to market products in a way that certainly harmed health.

When the public health faculty at Tufts and the law faculty at Northeastern joined forces to establish the Public Health Advocacy Institute, one of our first projects was Legal Approaches to the Obesity Epidemic¹, a symposium published in the Journal of Public Health Policy, in 2004. It attracted a great deal of attention and JPHP became a favorite place to publish research on obesity.

But I was not entirely pleased, because although the research was usually methodologically sound, it often missed Marion’s point and the focus of the PHAI symposium. Most submissions concentrated on individual behavior and personal responsibility. In 2010, I asked Marion, who was on the JPHP editorial board to join me in writing an Editorial: ‘Obesity as collateral damage: a call for papers on the Obesity Epidemic’.² We had ‘come to believe that research studies concentrating on personal behavior and responsibility as causes of the obesity epidemic do little but offer cover to an industry seeking to downplay its own responsibility’. We urged ‘authors to submit articles that consider how to understand and change the behavior of the food industry’.

Imagine our pleasure in learning that starting this June, PLoS Medicine will publish a series of articles exploring the food industry’s involvement in health with Marion Nestle as a guest editor. To PLoS Medicine, we say bravo!

References

1. Journal of Public Health Policy (2004) Special section: Legal approaches to the obesity epidemic. 25(3&4): 346–434.
2. Robbins, A. and Nestle, M. (2011) Obesity as collateral damage: A call for papers on the Obesity Epidemic. Journal of Public Health Policy 32(2): 143-145.

 *Journal of Public Health Policy (2012) 33, 285–286. doi:10.1057/jphp.2012.25

A blog post from Fernando Quintero on the Berkeley Media Studies Group’s site alerted me to PepsiCo’s latest example of corporate social responsibility: an additional $50,000 donation for scholarships and internships to the National Association of Hispanic Journalists bringing the total to $100,000.

Hispanic populations in the United States have higher than average rates of obesity, type 2 diabetes, and other chronic conditions associated with overconsumption of sodas and snacks.

Such generosity raises questions about what Pepsi is buying from this group.

The NAHJ says:

We are thrilled to have PepsiCo as a new partner committed to building a stronger Latino community,” said Ivan Roman, Executive Director for NAHJ. “The company’s support as we get more Hispanics into journalism to tell our stories is key to making sure our communities are represented fairly in the news media, while giving them a louder voice in the civic dialogue.

Why do I think that journalists in this Association are unlikely to be telling stories like these:

• The relationship of soda and snack consumption to obesity and type 2 diabetes in Hispanic communities
• The relationship of soda and snack consumption to Hispanic childhood obesity
• How soda intake among Hispanic children leads to dental decay
• Soda company marketing practices in Hispanic communities
• The effects of soda and snack marketing on dietary practices and health in countries in Latin America

Pepsi says:

As part of La Promesa de PepsiCo, the company is building relationships with the community, strengthening its strategic partnerships, and sponsoring national Hispanic organizations like: CHCI (Congressional Hispanic Caucus Institute), HACR (Hispanic Association on Corporate Responsibility), LULAC (League of United Latin American Citizens), NAHJ (National Association of Hispanic Journalists), and NCLR (National Council of La Raza) among others.

A page from the tobacco-industry playbook, no?

I’ve been at meetings in London and Geneva on non-communicable (what we call chronic) diseases and how to prevent them. 

On the way to Europe, I did some catching up on reading past issues of The Lancet and ran across this letter from Sally Casswell of the School of Public Health at Massey University in Auckland. 

Professor Casswell was responding to an article arguing that a major priority in chronic disease prevention should be to strengthen the capacity of countries to deliver primary care services.

Yes, professor Casswell writes, primary care is important.  But it is even more important to focus prevention efforts on the environmental factors that influence the behavior of individuals and cause them to need primary care services in the first place.

Do we really want to continue to live in a world where the oversupply and marketing of tobacco, alcohol, unhealthy processed foods, and soft drinks is tolerated simply to allow continuing profits for the shareholders of the transnational corporations producing and distributing them, while the taxpayer funds the health services and pharmaceutical response to the ensuing disease and injury?

This is a refreshing way to look at this problem, and one well worth pondering.

The third part of the PLoS Medicine series on Big Food (which I co-edited with David Stuckler) is now out.  Happy Fourth of July!

Here’s the entire PLoS collection of papers on this topic:

Editorial: PLoS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny, The PLoS Medicine Editors, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001246

Essay: Big Food, Food Systems, and Global Health, David Stuckler, Marion Nestle, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001242

Essay: The Impact of Transnational “Big Food” Companies on the South: A View from Brazil, Carlos A. Monteiro, Geoffrey Cannon, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001252

Perspective: Thinking Forward: The Quicksand of Appeasing the Food Industry, Kelly D. Brownell, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001254

Policy Forum: Soda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?, Lori Dorfman, Andrew Cheyne, Lissy C. Friedman, Asiya Wadud, Mark Gottlieb, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001241

Policy Forum: Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco, David Stuckler, Martin McKee, Shah Ebrahim, Sanjay Basu, PLoS Medicine: Published 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001235

Policy Forum: “Big Food,” the Consumer Food Environment, Health, and the Policy Response in South Africa, Ehimario U. Igumbor, David Sanders, Thandi R. Puoane, Lungiswa Tsolekile, Cassandra Schwarz, Christopher Purdy, Rina Swart, Solange Durão, Corinna Hawkes, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001253