As I see it
Philip James writes: Throughout our Rio2012 conference, constant reference was made to the absence of funding from conflicted industry. This deliberate policy may well have encouraged the Brazilian government at federal, state and municipal levels, and especially the federal Ministry of Health, to support the meeting and ensure its success. Now back in Europe from the experience of Rio2012, I notice by contrast that most conference organisers seem to think they are not doing their job unless everything is slick and glamorously organised. So registration fees go through the roof – unless the organisers also recruit big sponsorship from industry to make the conference also a marvellous commercial marketing opportunity. Which is what they usually do.
Gastronomic delights in Lyon
Thus, Rio2012 was in striking contrast with ECO2012, the 19th European Conference on Obesity in Lyon, France, where the international experts on the science of obesity held their annual meeting from 9-12 May in the vast conference centre by the river. I was there as president of the International Association for the Study of Obesity.(IASO). To quote from the programme: 'The congress will take place at La Cité Internationale, an architectural marvel designed by architect Renzo Piano, who also lent his talents to the New York Times building on 42nd Street in Manhattan and the Pompidou Centre in Paris. La Cité Internationale is distinctly modern in sharp contrast to its traditional French surroundings, but doesn't sacrifice a strong focus on fine dining. The open-air complex includes hotels, convention space, apartments, shops, museums, and restaurants'.
The tracks of the meeting were environment and prevention; epidemiology and cellular mechanisms; integrated biology and inter-organ crosstalk; genes, molecular and cellular mechanisms; and clinical practice and multi-disciplinary management. There was also a theme of childhood obesity.
Rio2012 had sensitised me to commercial presence in scientific conferences. At ECO2012 an elegant opening ceremony was addressed by a passionate renowned French chef. He absolutely took on board modern approaches to nutrition, and now in his retirement, is setting up a special school for chefs, challenging them to produce exquisite food with an appropriate nutrition content,to enhance – and even prolong! – the traditional life-giving importance of the French way of eating.
In passing he said that the Chairman of Nestlé had chosen him to help the company – the biggest manufacturer of branded food products in the world – to improve its range, and that he has already enjoyed a marvellous decades-long challenge working for Nestlé. He then invited us to the evening welcome reception with its special prepared canapés, which were indeed exquisite. So we guessed that this was one of Nestle's contributions to the conference as well as their having a large stand at the meeting. Danone, the transnational food corporation whose headquarters are in France, provided free bottles of water, and the lunches were of a very much higher gastronomic quality than those usually available at such meetings. Other commercial sponsors were in evidence – some food and drink manufacturers, others pharmaceutical.
What's up at WHO?
Then from 21-26 May the World Health Organization held its 65th Assembly in Geneva. Papers circulated in advance looked bad. Thus linked here is the proposed programme for WHO reform, circulated in late April. It's also available at http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_5Add1-en.pdf. The plan omits nutrition as an entity, subsuming it under two headings – non-communicable diseases, and life cycle issues. On a quick check I did not see the word 'nutrition' in the document at all!
How can this be? Nutritional abnormalities now vie with tobacco use (also not mentioned in the WHO reform plan) as the key determinants of what is the economically overwhelming epidemic of obesity and other chronic diseases, with four-fifths of the burden already being borne in low and middle income countries. Has WHO given up on the Millennium Development Goals, where nutrition plays a pivotal role, which are now starting to be reviewed in anticipation of the 2015 time-line set for their substantial modification? It seems not – in the reform plan, these major nutritional issues are being subsumed within the life-cycle theme, and the MDGs are mentioned in this context.
But nutrition has been neglected within the UN system for at least the last 20 years. Oddly enough, I think this is partly the fault of our profession. We moan about this neglect. But we have not presented our case with scintillating scientific rigour and élan, combined with deployment of diplomatic and policy skills, to lead and seize control of the political agenda. This is what leading professionals in other fields have succeeded in doing. We need to create a new vision of nutrition as a fascinating and challenging integrative theme, when considering the world's food systems at a time of rapid climate change, economic crises, and ever more constrained natural resources for the planet's escalating population. The Rio2012 Declaration, whose introduction is published in World Nutrition this month, touches on this theme.
IASO has formal relations with WHO, and so is recognised in World Health Assemblies. At last month's meeting we did our bit, in partnership with the Association, the UK National Heart Forum, World Cancer Research Fund International, World Action on Salt and Health, and also Consumers International which like IASO is in formal relations with WHO.
We formally submitted a short statement on the importance of considering nutritional issues in a broader context. You can access the pdf here, and also at. http://www.iaso.org/site_media/uploads/WHA_Statement_Final230512-2.pdf. Fortunately Margaret Chan, WHO director-general, was in the chamber at the time, and made a clear gesture to Francesco Branca, the WHO lead official on nutrition, indicating she agrees that the issue of nutrition is important.
Being independent and getting real
The contrast between the Rio2012 conference in Rio, and the ECO2012 conference in Lyon, has made me think about relations with industry, including commercial sponsorship. I am reminded that Ban Ki-moon, the Secretary General of the UN, has called on all UN agencies to engage 'the private sector', as a necessary part of an intersectoral approach to non-communicable diseases and also to many other health and development issues and crises.
My guess is that most national governments will follow this advice. I doubt whether there are many governments which, as Brazil has done, will persevere in giving substantial support to public health and nutrition conferences, in the knowledge that no sponsorship will come from industry. To the contrary: my guess is that most governments will push the academic and professional world to do the opposite, and will stipulate that organisers first engage industry support and presence before they consider support from public money for a meeting such as that held in Rio.
I hope I am wrong. But I have to remind myself that for the first 30 years of my academic life I never had to depend on commercial interests either to further my career or support my research. During this time I lived in what we call in the UK an 'ivory tower', divorced from the reality of most other nutritionists, scientists and physicians struggling to work without private funds. Now, I am now moving to the view that the real challenge now, is to identify non-conflicted industry with whom we can work. Actually, I am inclined to go further, and think we need to find ways of engaging honourably with conflicted industries, so that they do not merely use our conferences and other initiatives as marketing mechanisms and in this way frustrate our purposes and impede public health nutrition.
This won't be easy, and as I say, I may be mistaken. When I first served on UK government committees relating to the food industry back in the 1970s, I was taken aside by a venerable committee chairman and given several official reports to read. This was after I had suggested in committee that industry could use voluntary measures to address food problems. When reading these meticulous reports from the archives of the then UK Ministry of Agriculture, Fisheries and Food, I learned that voluntary measures rarely work. Could they work now? The evidence is not there.
Participants at Rio2012 will remember the constant discussion on how to address conflicted industry. I trust this will also be addressed in the conference's final report. It is becoming a burning issue. The challenge is how to deal with industry in ways that re-capture the high ground of policy-making, so that we can indeed, in real partnerships, make progress in population nutritional health and well-being.