Down from the UN NCD Summit Science to policy to action on obesity, chronic diseases, in Latin America

Transcription

1 Down from the UN NCD Summit Science to policy to action on obesity, chronic diseases, in Latin America Making music in Valparaiso, Chile. At right: Association members/speakers Ricardo Uauy, Pekka Puska (centre) and Josep Tur (right) with Chilean hosts The news team reports. From science, to policy and action. Responsibility for prevention and control of obesity, diabetes, heart disease and cancer is now, after the September UN meeting, passed to national governments, who in New York committed themselves to real progress by the end of next year. Association members came from Europe and many Latin American countries to Valparaiso, Chile, between October, in support of the first top-level regional summit held after the New York meeting. The invitation came from president of the Chilean senate Guido Girardi Lavin (above, second from left) who ranks next to the president of Chile. He is seen with the mayor of Valparaiso (second from the right), and three Association speakers, Ricardo Uauy (Chile), Pekka Puska (Finland), and Josep Tur (Spain). The summit ended with the Valparaiso Declaration, for Latin America and the Caribbean. Association member/speaker Juan Rivera with Chilean faces (left); filming in the Chilean National Congress (centre); signs of protest in the streets (right)

2 62. Call upon WHO, in collaboration with Member States through the governing bodies of WHO, and in collaboration with United Nations agencies, funds and programmes, and other relevant regional and international organizations, as appropriate, building on the work already under way, to prepare recommendations for a set of voluntary global targets for the prevention and control of non-communicable diseases, before the end of Consider the development of national targets and indicators based on national situations, building on guidance provided by WHO, to focus on efforts to address the impacts of non-communicable diseases, and to assess the progress made in the prevention and control of non-communicable diseases and their risk factors and determinants. UN High-Level Meeting on NCDs. Political Declaration, Clauses 62, 63 The news team reports. Action to prevent and control obesity, diabetes, heart disease and cancer, pledged at the UN High-Level Meeting in September, now passes to UN member state governments. This is indicated in the UN meeting Political Declaration (see above). The first summit after New York was held in Chile, at the invitation of the president of the Chilean Senate Guido Girardi Lavin (seen in the pictures below). The conference was on behalf of Latin America and the Caribbean, and guests and speakers came from 12 countries in the Americas outside Chile. Association members from Europe and Latin America came to speak at and support the Chilean initiative. Its leading advisor was previous director of the Chilean national nutrition institute Ricardo Uauy (seen in picture below, right). Other Association speakers were Pekka Puska (below, left), director of the national institute for public health, Finland; Juan Rivera, head of nutrition at the national school of public health, Mexico; Philip James, president of the International Association for the Study of Obesity, London; Geoffrey Cannon, of World Cancer Research Fund International and the American Institute for Cancer Research; and Carlos Monteiro, professor of public health nutrition at the University of Sao Paulo, Brazil. Pekka Puska (left) calling for action, with senate president Guido Girardi, also seen with Ricardo Uauy (right) working on thevalparaiso Declaration

3 The conference was held in the grand Chilean National Congress building in Valparaiso, with up to 1,500 people present. Impressive staging and constant film and media coverage was masterminded by leading Chilean film director Rodrigo Sepúlveda and his team. Speakers were conscious that their presentations were made from a podium where Chilean national leaders have spoken. The event took place at a time of tumult in Chile, with students demonstrating in the streets against the government s decision to increase the burden of tuition fees, already among the highest in the world. So are the rates of overweight and obesity. Some speakers at the conference spoke of the link between the commercialisation of education and the privatisation of public health. Keeping customers in the dark In a dramatic session, Philip James and Chilean consumer organisation leader Cecilia Castillo spoke out eloquently and forcefully in favour of a traffic light system of nutrition labelling, with strong and vocal support from many of those present in the chamber. The GDA (Guideline Daily Amounts) labelling system favoured by industry and its organisation Sofafa, representing 2,500 Chilean companies, and so far by the Chilean government, is widely seen to be complex and obscure intentionally so, some speakers claimed. As in other countries, the Chilean food manufacturing industry is also opposed to fiscal policies designed to make fresh and other healthy food less expensive and more available and unhealthy ultra-processed products less cheap. They say this would be a socially regressive tax directed against impoverished families. However, Senate President Guido Girardo agreed with Cecilia Castillo. Children understand the traffic light system, he said, whereas they do not understand the GDA system. Nor, he stated, did his colleagues in government. He said: Anything not understood by children is not worthwhile. In his view the GDA system was designed not to be understood. The market doesn t operate where there is no symmetry in information. Ultra-processed thinking A number of types of thinking were evident in the conference. First, a number of invited speakers were from transnational food and drink product manufacturers, including McDonald s, Pepsi-Co and Nestlé, as well as from Sofofa and other Chilean processed product organisations. We all agree said one industry speaker, that obesity and chronic diseases are a multifactoral problem. Woods Staton, the CEO of Arcos Dorados, representing the biggest McDonald s system of franchises in the world, caused some merriment by stating that I am representing an enterprise that does not produce processed food and that McDonald s is not a fast food enterprise. However, he is supported in this claim by food classifications in the US

4 and elsewhere that identify hamburgers as fresh meat. As for French fries, he pointed out that these could be eaten together with corn and tomatoes, or salad. As in other countries, the position of the transnational and other big companies is that freedom of choice should be protected, and that public programmes to prevent obesity and other diseases should be largely confined to information and education of the individual consumer. Industry is adamantly opposed to any statutory regulation of their activities, and in many countries their investment in new factories and other initiatives is conditional on maintenance of their commercial freedom. In Chile and other countries those who insist on the need for law to regulate food supplies, once identified by industry as food terrorists, are now positioned by industry and its media relations advisors as the Food Taliban. Most transnationals are also committed to voluntary reduction of salt and trans-fat in some of their products, although as Diego Cifone, PepsiCo director of corporate affairs for the Southern Cone countries said, this was not because we recognise that we were doing anything wrong previously. In a final presentation, Fernando del Solar, president of Nestlé in Chile and other Latin American countries, said that his company had supported the Chilean government for 20 years (including during the military regime of Augusto Pinochet) to eliminate childhood malnutrition. What worked, he said, was team playing, and Nestlé stood ready to support the government in prevention and control of obesity now. Choosing to live healthy Second, Chile s Elige Vivir Sano (Choose a Healthy Life) programme, adopted by government, is headed by the country s First Lady Cecilia Morel de Piñera. Supported with funds from industry. It has much in common with Michelle Obama s Healthy Living programme. Speaking at the conference, the First Lady said that Chile s programme is in favour of not advertising junk food and not selling junk food in schools. People value a healthy life more than anything else she said. She stressed the need for healthy ways of life enjoy your body and live with your family, and be happy. People should eat more fruit and vegetables, drink more water, and consume less salt, she said. Pauline Kantor, director of Elige Vivir Sano, added that its aims include lower consumption of sugars and fats, and smaller portion sizes. It seemed likely in the meeting that its outcome, for Chile, will remain food and nutrition policies that do not significantly conflict with the interests of the manufacturers of ultra-processed products. A possible exception may be laws protecting the health of children.

5 Laws protect public goods Third, and by contrast, most of the invited speakers from outside Chile emphasised that the ultra-processed products made by transnational companies are unhealthy. They also stated that industry self-regulation does not work, and that all organised activities need formal rules. One analogy given was with Formula 1 racing. As long as the rules were controlled by the motor manufacturers, races were won by the most reckless drivers, who often killed themselves and other drivers, and sometimes also spectators when debris from crashed cars fell into the crowd. Now, racing has greater coverage and greater turnover, and is relatively safe, because the drivers themselves insisted in proper safety measures. By analogy, without formal regulation, responsible food and drink product manufacturers are at the mercy of their most ruthless and reckless competitors. It follows that the manufacturers of ultra-processed products need, and should want, statutory regulation. One presenter said that in private, industry executives often agree with this position. Most of the international invited speakers made clear, in various ways, that publicprivate partnerships with industry whose products are harmful to public health, do not and cannot work. This was stated clearly by Juan Rivera, Carlos Monteiro and Philip James, from experience in Mexico, Brazil and Britain, by Cecilia Castillo, and in a brilliant presentation by Jaime Delgado from Peru. Geoffrey Cannon presented the Hyderabad Statement, agreed at a special meeting of experts concerned with law and public health. This is All significant developments in public health involve and require the use of law. This is a rule to which there is no exception. Speakers mentioned the proposal made at the New York High-Level Meeting, that industry whose interests conflict with those of public health need to be engaged in the implementation of public health policies and actions, but not in their formulation. The most forceful presentation came from Guido Girardi himself. He insisted that the term non-communicable diseases is a mistake, and that chronic diseases are even more transmissible than those of which the infectious agent is microbial. In the case of chronic diseases, the causes, he said, include addictive substances like salt and sugar, social, economic and political pressures, and industry advertising and marketing. Commenting, one of the speakers said he had heard a suggestion that the term non-communicable disease had first been suggested by somebody from Coca- Cola. Guido Girardi stated that national polls taken in Chile show that 90 per cent of the population want laws to be confirmed, passed and enforced that protect public health and public goods. Finally, Ricardo Uauy presented the Valparaiso Declaration in finished draft form, which had been worked on throughout the conference. Comments are being received as this issue of our website is published. It so far contains some crucial points. This include that the prime responsibility of governments is to govern, in the public interest, and that the use of law and regulation to protect and enhance the

6 freedoms of nations, communities and families is essential. It also includes the point that chronic diseases are transmissible. What Margaret Chan says The day after the Valparaiso meeting, the World Conference on Social Determinants of Health opened in Rio de Janeiro. WHO director-general Margaret Chan stated: Prevention is by far the best option But nearly all the risk factors lie out of the control of the health sector, such as junk food, tobacco, alcohol and sedentary lives. Prevention measures lie as well outside the health sector Vast collateral damage to health is being caused by policies made in other sectors and in the international system She went on to say: Putting good policies in place means pushing against powerful and pervasive commercial interests. Every corner of the world is fighting against obesity and overweight, which is rising particularly in children. This is not a failure of individual will power, but a failure of political will at the highest level. Kids in the whole world watch cartoon characters who tell them what to eat and drink, And so what can be done? Two weeks ago, France passed a fat tax on sugary drinks, and was immediately threatened by a company producing such drinks. Will governments now put the health of people before the interest of corporations? Will Latin American countries rise to this challenge?