Moving forward the NCD agenda - an update from the 68th World Health Assembly
Author: Hannah Brinsden
World Obesity Federation and City University, London
For the last few years the non-communicable disease (NCD) agenda at the World Health Assembly (WHA) has been one of the main topics for discussion. This year however was different and on first glance NCDs seemed to be a low priority agenda item. Ebola was this year’s Hot Topic, and rightly so, with much to discuss both in terms of moving forward but also preventing a similar crisis in the future. Initially I felt a little indignant that NCDs were being scheduled for the end of the week, but as soon as I was in Geneva at the Palais the reality hit me. Of course NCDs were not taking pride of place in the Committee meetings. Agreement has been reached, declarations have been signed. In fact, we’re entering a new phase in the NCD agenda, no longer one of discussion but one of action. The 2014 UN Summit on NCDs focused on turning the global targets that were agreed in 2013 into national action. This shifts the discussion towards side events focused on sharing experiences, learning from each other and understanding the available options for getting to grips with NCDs and obesity. The NCD-related side events were plentiful which was encouraging to see and shows how all the ‘talk’ from the last 5 years is really starting to come together.
This year there were three important Member State-led side events on obesity and diet: one organised by the BRICS Member States focused on nutrition as post-ICN2 follow up, another on tackling obesity through better nutrition jointly organised by Indonesia, Ecuador, Paraguay and Australia, as well as the WHO’s own NCD technical briefing. These sessions had a number of commonalities, including agreement of the urgency for action, the value of exchanging experiences and the need for fundamental changes to the food system. A number of specific examples of nutrition policies being implemented were highlighted by the Member States, including reformulation policies, particularly for salt, marketing policies, food-based dietary guidelines, interpretative nutrition labelling on processed foods, fiscal measures and school-based interventions and education.
While it was clear that countries are starting to make some good progress, it was also clear that no country has addressed the food and nutrition crisis we face today through a comprehensive set of policies. Yes, there are examples of the range of policies being implemented but not by a single country. In order to have the greatest effect, and to ensure that the NCD targets and ICN2 commitments are met, I would argue that governments need to implement a full package of consistent multi-sectoral policies which go beyond the global commitments outlined in the Global Action Plan for NCDs. Studies examining the cost-effectiveness of policies to tackle obesity, such as labelling, marketing restrictions and reformulation, consistently show these to be the most effective interventions, however simple maths indicates the combined benefit will be greater still.
It was also apparent that in some cases, there remains an issue of political will. Not the political will to tackle NCDs and obesity per sae, rather the political will to address the corporate drivers of these health issues. This leaves governments exposed to weak and voluntary policies and a leniency in favour of corporations rather than public good. Regulatory action however is vital if meaningful progress is to be made, as recognised by the Regional Director of PAHO, Dr Carissa Etienne who said in one side event “The food industry is not going to change willingly. We need strong legislation and regulation”. The nature of global food trade and markets coupled with corporate power, means that national governments may struggle to take the regulatory actions they know are best for their citizens health. As such, if we are to truly improve the global state of nutrition and strengthen national food sovereignty, a legally-binding Global Convention to protect and support governments, particularly in regional economic areas and smaller nations, is required. Having a legally binding mechanism at the global level will help to define minimum nutritional standards to drive commercial food markets and the operation of global food trade as well as ensure that governments are able to enact the policies required and will help to protect government and citizens from commercial interests and food markets which often undermine efforts to promote food and nutrition security.
For this reason, World Obesity and Consumers International, with the support of over 300 public interest organisations around the world, are calling for the development of a legally binding treaty or Framework Convention to Protect and Promote Healthy Diets, similar to the Framework Convention on Tobacco Control (FCTC). The FCTC has helped and supported the world’s governments in enacting measures required to tackle the tobacco market, as well as tobacco consumption. Although the comparison of food to tobacco is controversial, after all we need some food but don’t need tobacco, that doesn’t mean that similar mechanisms and policies can’t be employed. Although we need food we don’t need many of the products available to us today such as sugar-sweetened beverages, chocolate bars, crisps and other snack products. Restrictions on the sale and promotion of these products could therefore take a similar approach to that of tobacco control. The UN Special Rapporteur on the Right to Food 2010-2014, Olivier de Schutter supports this notion, saying “Just as the world came together to regulate the risks of tobacco, a bold framework convention on adequate diets must now be agreed” while the UN Special Rapporteur on Cultural Rights 2012-present, Farida Shaheed said in the 2014 report “Food advertising and promotion have contributed to shifting dietary patterns towards those closely linked with non-communicable diseases. By promoting mainly manufactured products with a high content of fat, sugar or salt, food and beverage companies contribute to altering previous eating and cooking practices that often were healthier and more ecologically sound … Safeguards need to be made more effective”.
So returning to this year’s WHA, the side events taught us the range of actions and progress that is being made, and thus showing that such actions are possible. At the same time, some of the challenges were highlighted, for instance associated with funding and corporate influence and challenges. The underlying message that I took home however is that yes progress is being made, and governments need to be congratulated for that, but it is being made too slowly, and much more needs to be done to truly get to grips with the global food economy, food system and burden of obesity and NCDs.
*The views here are my own and do not reflect the views of either organisation.