The biggest causes of ill health in all but the very least developed countries are now non-communicable or chronic diseases. Lung cancer from smoking, obesity from an unhealthy diet and liver problems from alcohol are killing millions of people each year. If we’re to reach the World Health Organization’s 25-by-25 target (reducing the incidence of non-communicable diseases by 25% by 2025), we need concerted action to reduce consumption of unhealthy commodities.
Western nations have had some (albeit small) success in curbing these problems, with regulation and policy proving to be particularly effective for tobacco control. But lifestyle-related diseases are now increasing at an alarming rate in low- and middle-income countries and require urgent action.
A new international analysis of food, drink, and alcohol industry involvement in policies aimed at tackling non-communicable diseases (published as part of a series today in The Lancet), shows that despite government reliance on industry self-regulation and public-private partnerships to improve public health, there’s no evidence to support either their effectiveness or safety.
So the role of the processed food, tobacco and alcohol industries in tackling lifestyle diseases must be re-assessed if we want to see change in public behaviour around food.
The key task now is to make recommendations for governments, public health professionals, and society on the involvement of these industries. We would like to start with the proposal that industry should have no role in forming national or international policy on chronic disease prevention and mitigation. This is because “unhealthy commodity” industries are using similar strategies to the tobacco industry to undermine public health policies and programmes.
Regulation, or the threat of regulation, is the only way to change the behaviour of these transnational corporations. It has changed the way the tobacco industry operates and it could have the same beneficial effects on the food industry. Through the sale and aggressive marketing of tobacco, alcohol, and ultra-processed food and drink, multinational corporations are now major drivers of the world’s growing epidemics of chronic diseases.
Most health problems in Australia are now attributable to a poor diet, insufficient physical activity, tobacco or alcohol. This means we have to move on processed and fast foods in the same way that we have on tobacco. Foods high in salt, fat, sugar and calories are unfortunately a great way for the industry to make profit, so voluntary solutions are unlikely to work.
It’s for very good commercial reasons that the food industry systematically waters down public health reform proposals and plays a central role in influencing public behaviour through sophisticated marketing practices, without concern for the long-term health outcomes.
And self-regulation is often just another way to block public health efforts. We have been working with industry and government for five years now to reduce the amount of salt in food, for instance. After all these years, the best evidence we have suggests that average salt levels in the Australian food supply have gone up, not down.
Clearly, we need to find a way to put health ahead of profit. The UK Food Standards Agency, which was launched in the aftermath of the mad cow or bovine spongiform encephalopathy (BSE) outbreak in the United Kingdom, is one example of a good solution. The agency board was appointed to act in the public interest; it was given a unique statutory right to publish all advice it provided to ministers; and it committed to make decisions about food policy only at open board meetings. And it delivered – foods in the United Kingdom are systematically less salty than in Australia.
Despite business sector concern, action toward healthier food needn’t harm industry. When business was forced to cut salt from foods in the United Kingdom, the sector didn’t miss a beat. There were no mass redundancies, corporate failures or lost markets, just thousands fewer strokes and heart attacks each year.
Our Lancet study also shows that saturation of markets in high-income countries means that the food and alcohol industries are now focusing on emerging global markets, just as the tobacco industry did. Almost all foreseeable growth in the profits of these industries selling unhealthy commodities will be in low-income and middle-income countries where consumption is currently low. We clearly need to protect our poorer neighbours, who do not have as many resources to spend on health, from their profit motive as much we need to protect ourselves.