Volume 2, Number 8,September 2011
Journal of the World Public Health Nutrition Association
Published monthly at www.wphna.org
The Association is an affiliated body of the International Union of Nutritional Sciences For membership and for other contributions, news, columns and services, go to: www.wphna.org
The UN summit on non-communicable diseases
Access the August news story on the Summit process here
Access the pdf of the cover of this month's WN here
Access the pdf of this editorial here
Access the pdf of WN commentary by Philip James here
Access the pdf of the 11 WN short commentaries here
A child with diabetes, a woman receiving radiation, a man with respiratory disease. Are populations being abandoned to the fate of pandemic NCDs?
Parturient montes, nascetur ridiculus mus. 'The mountains will be in labour, and a ridiculous mouse will be born'. This line of Quintus Horatius Flaccus (Horace) occasionally occurs to observers of the grand processes leading up to meetings of the mighty that are commonly known as 'summits'. Jokes are also made about queens believed to be pregnant with a child meant to be a monarch, but who eventually issue a great blast of wind. Is this how it will be at the UN NCD Summit, taking place in New York this month on 19-20 September?
A stab from The Lancet
Many observers think so. On 20 August The Lancet published a sardonic editorial comment, saying: 'What looked like an opportunity to rewrite the world's agenda for global health is now turning into a fiasco, one in which corporations are successfully applying pressure to governments to block any attempt to produce an outcomes document with teeth'. The draft Political Declaration, also known as the Outcomes Document, is now the subject of suggested revision by member states. The drafts have been leaked, as can be seen from last month's news story on our website, and also from Philip James's magisterial commentary to which this editorial is an introduction.
With reference to the draft Declaration, The Lancet editorial continues: 'The European Union, for example, wishes to delete a paragraph saying that resources devoted to NCDs are not commensurate with the magnitude of the problem. The G77 group of nations wishes to retain that truthful statement of fact... On targets, the G77 wants WHO to establish global goals by the end of 2012. The US fiercely opposes this recommendation, preferring instead only voluntary targets. Major tobacco manufacturing nations, including Japan, the EU, and the US, oppose any language on tobacco taxation' ... And so on.
A thrust from The Alliance
The NCD Alliance, led by world professional federations concerned with diabetes, heart disease, cancer and respiratory diseases, are up in arms. Their leaders wrote to UN secretary-general Ban Ki-moon on 17 August as follows. 'Member State negotiations on the draft Political Declaration… stalled on 5 August.... It is reported that sound proposals for the draft Declaration to include time-bound commitments and targets are being systematically deleted, diluted and downgraded….This is simply unacceptable'.
The Lancet concludes: 'For all their fine words about commitments to global health, the capitulation of EU nations and the US government to the tobacco, food, and drinks industries reveals their true allegiances – not to those at risk of chronic diseases, but to businesses growing fat on the early deaths of their consumers'.
The Association letter
This is not the position of the Association. It is true that the outcome of the New York summit will fall far short of the hopes and initial expectations of all concerned with public health. What The Lancet and the NCD Alliance state is true. But in a letter to UN secretary-general Ban Ki-moon (pdf available here) the Association says: 'We believe that a modest outcome, and a general Declaration of commitment, should be seen as a first stage and a preliminary success, and not as a failure'.
Association president Barrie Margetts says: 'Expectations have been unrealistic. The process is not yet mature. We have been hoping for too much too soon'. He adds: 'The main message, which we need to take on board now, is that we need to regroup so as to be more persuasive and more effective. This must engage us, as professionals and citizens, and we need to learn from the environmental movement'.
The nature of UN high level meetings
Association Council member Philip James has as much experience of UN process as anybody now active, inside as well as outside the United Nations system. In his commentary this month, he points out that: 'A meeting held at ministerial rather than head of state and government level is not designed to agree new policies, like for example the Millennium Development Goals. We in our profession know that pandemic chronic diseases amount to a global crisis, that they have social, economic and environmental as well as behavioural and biological determinants, and that they can be prevented only by concerted action involving all appropriate actors'.
He continues: 'We need to see that it is not a trivial achievement to have this agreed at the UN General Assembly, at a time in history when government leaders have much else on their minds. The task now is to translate general principles into policies and actions at continental, regional and national level. We need to play a leading and guiding part in this work. So we must look ahead. Any general conclusion that the process has failed, and worse that it should not be attempted again, would benefit only those who gain by the abandonment of world affairs to "the market", which everybody should know has failed'.
There is much to do now
There is now much to do, in preparation for a real UN summit, at head of state and government level. Champions of public health should not be too hasty to insist on this too soon. Far more than what is mentioned by the NCD Alliance is missing from the draft Declaration, as Box 1 shows. In a long document with 57 clauses there is nothing about increase in population. There is no reference to economic globalisation and just one suggested mention of urbanisation. Transnational industries are not mentioned. Conflicts of interest are suggested once. Food processing is mentioned once, in passing. Primary producers, traditional food patterns, and rural economies, are not mentioned. Proposals for legislation and regulation and taxation, offered as tentative options, are marked as crossed out by the US and EU. Primary producers, farmers? Nothing. Dietary patterns, meals, foods? Nothing. Breastfeeding? Yes, and this will probably survive. Infant formula? Nothing, no mention.
Issues overlooked or neglected in the
draft UN NCD Summit Political Declaration
The Declaration in draft (version of 29 July) has 28 pages with 57 clauses (or paragraphs) Its stress throughout is on combining prevention and control of NCDs with economic expansion, development, and productivity, all of which will increase environmental impact. It mentions social and economic determinants (or factors) several times, and environmental factors sometimes, but as shown here, is seldom specific. There is no note of concern about the role of industry in NCDs, except that advertising to children is mentioned twice. 'The private sector' is always positioned as part of the solution. The draft includes many suggestions from member states for alternative wording. The much-disputed paragraphs 38-41 are hard to decipher. The final Declaration will eliminate alternatives and is likely to be shorter
In the list below, items shown in BOLD are evidently firmly in the Declaration. Items shown in light type and in italic are suggestions made by some member states which may not (and sometimes almost certainly will not) survive.NO means there is no mention. Items marked as crossed out in the draft declaration are not listed here.
|Poverty||15 16 23 49|
|Equity, justice||35 37|
|Conflicts of interest (industry)||43|
|Marketing (1)||2738 4043|
|Food prices, food crisis||25|
|Fresh food, grains, vegetables, fruits||NO|
|Saturated fat (1)||38 40 40 43|
|Trans fats||3840 40 43|
|Sugar (1)||3840 40 43|
|Salt (1)||38 4043|
|Legislation, regulation (1)||38 40|
|Taxation, fiscal measures, bans (1)||38 40|
Necessary policies and actions
A new Declaration, agreed at head of state and government level, needs to have the power and precision of the Millennium Development Goals. Some crucial policies follow here:
1 Obesity needs to be identified as a non-communicable disease
Obesity and also other serious chronic diseases should be bracketed with diabetes, cardiovascular diseases, relevant respiratory diseases, and cancer.
2 Rational policies require quantification to become effective actions
Quantified time-based goals and targets are needed, for relevant dietary patterns, foods, products and nutrients, and for the prevention, control and reduction of relevant diseases. These should be expressed in the form of ranges, to allow for different circumstances, should be made binding on industry, and should be independently monitored.
3 Protection and improvement of public health always involves the use of law
Statutory instruments are and need to be an invariable and integral part of international and national strategy.
4 The role of conflicted industry needs to be limited
That part of the food and drink industry manufacturing and processing and other sectors of industry whose policies and practices conflict with the interests of public health, should not be identified as partners in policy formulation, but solely in policy implementation.
5 Early life exposures are the most crucial
The highest priority need to be given to early life. Greater stress needs be given to breastfeeding, the quality of weaning food, the marketing of food to children, to school meals, and to the nutrition of young women. Law must be used to protect the health, welfare and well-being of children and of young women before and during pregnancy.
6 Traditional food systems need emphasis and protection
Traditional and established food systems, as well as indigenous food systems, need protection and support.
7 Fresh and minimally processed food needs promotion
Well-resourced programmes, involving partnerships between all relevant government departments as well as other actors, are needed for protection, production, distribution, marketing, sale and consumption of healthy fresh and minimally processed foods
8 Saturated fats in industrial food supplies need to be sharply reduced
The energy density of manufactured products needs to be sharply reduced. This implies restriction and reduction of saturated fats, as well as trans-fats, sugars and salt, most of all in the manufacture of processed food and drink products.
9 Pathogenic types of processing need to be identified and restricted
Statutory as well as voluntary measures are required sharply to restrict and preferably eliminate the use of hydrogenation, and also all other forms of processing that singly or in combination generate pathogenic 'ultra-processed' products.
The tipping point
Most powerful UN member states, and in particular the US, remain devoted to 'the market'. This in effect means commercial freedom for transnational and other powerful food processors. This will change only when an increasing number of powerful governments recognise that 'the market' has failed, and that this is proved by successive finance, fuel – and food – crises. They will also have to recognise the implications of this failure. Thus, 'the market' in food needs to be regulated. More generally, legislators and officials need to accept and indeed celebrate the fact that governments have a prime responsibility to use law in the interest of public health and of public goods. Nothing much will change until heads of state and senior ministers, and their advisors, reach this 'tipping point' and, as a result, the ideology of individualism at almost all costs is replaced by a renewed philosophy which is in the interests of humanity, the living and physical world, and the biosphere. This time will come, but the worry is that it will come only after present policies and practices have destroyed too much of too many public goods.
The US position
There is though, a specific worry about the US. The legend is that all US presidents, going back many years, have been either Coke or Pepsi presidents, and have in return for support, been prepared to act as product placement for these sugared soft drinks, as if 'soda' is a US emblem, like the eagle on official insignia.
Be that as it may, politics in the US does suffer from what is sometimes called 'the Rockefeller doctrine'. Nelson Rockefeller, once US vice-president, observed; 'No candidate for any office can hope to get elected in this country without being photographed eating a hot dog'. As evidence of this, here are two of the very many similar photographs of Bill Clinton and Barack Obama on the stump and in public, in the last few years. As long as leading US politicians flaunt their habits of devouring fast food in public, we have reasons not to be cheerful.
Meanwhile, Horace made another phrase for us to remember. 'Nil desperandum', which is to say, 'never despair' or, more freely translated 'Have courage, and persevere'. Perhaps we should send some recipes for delicious meals to Michelle Obama, and ask her to tell her husband to enjoy them and to stop chowing do on junk food in the street and on camera.
Nelson Rockefeller on US politics: 'No candidate for any office can hope to get elected in this country without being photographed eating a hot dog'.
Acknowledgement and request
Readers are invited please to respond. Please use the response facility below. Readers may make use of the material in this editorial if acknowledgement is given to the Association, and WN is cited
Please cite as: Anon. The UN Summit on non-communicable diseased. [Editorial] World Nutrition, September 2011, 2, 8: 345-531. Obtainable at www.wphna.org
The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.
The Association's letter to UN secretary-general available as a pdf here, is an official position.