11th Annual Conference - Thriving in turbulent times - Challenges and Prospects
International Economic Forum of the Americas, Montreal Conference
Ladies and gentlemen,
Thank you for this opportunity to reflect on how obesity affects the prospects for thriving, from the point of view of the World Health Organization. Being overweight used to be seen as a sign of prosperity and social advantage, and still is in some societies. But now it is widely recognized as a health hazard. It can be just as dangerous as being undernourished. I will say a little about the extent of the global epidemic of obesity, its impact on health, and what we can do about it.
Overweight and obesity caused an estimated 2.6 million of the deaths that occurred globally in the year 2000.
The year 2000 was the target year set in the late 1970s by the global health community for achieving "Health for All". In those days and the early 1980s "health for all" still implied radical progress in controlling infectious diseases. Now, in 2005, we know that the infectious diseases were soon to be overtaken by chronic diseases as the main causes of premature death and disability. Not only that but the infectious diseases themselves, with the formidable addition of AIDS, turned out to be much less amenable to control measures than expected.
Today the estimated number of overweight people in the world is 1.5 billion. The death toll from diseases attributed to these conditions continues to rise in most parts of the world.
So the picture of global health has changed drastically in the last quarter of a century. Many of the dangers have become more apparent.
The numbers of people who are overweight are increasing most rapidly in low-income and middle-income countries. The new association of overweight with poverty has led to the troubling phenomenon of obese and underweight people living side by side in the same country, and even in the same household.
The traditional causes of malnutrition persist, such as poverty, parasitic diseases and contaminated drinking-water. But now, added to them are the health problems that have come with urbanization, globalized markets for cheap and energy-dense foods, changes in diet and food quality, and reduced physical activity.
Just as children are particularly vulnerable to infectious diseases, they are also becoming major sufferers of obesity. In the United Kingdom and many other countries obesity is rising rapidly in children under 11 years of age, and this is occurring mainly among the most disadvantaged people in the country. It reflects reduced physical activity together with a diet low in fruit and vegetables and high in sugar and saturated fats.
Overweight in childhood is a risk factor for chronic disease later in life. In fact adult-onset diabetes type II is now occurring in children as young as nine years old, which is a new phenomenon. Overweight is a major risk factor for chronic diseases such as cardiovascular conditions, stroke, cancer, and diabetes. Chronic diseases now account for 60% of the deaths that occur in the world every year, and 43% of the global burden of disease. These figures will probably become 73% of all deaths and 60% of the burden of disease by 2020. Eighty per cent of the deaths caused by chronic diseases now occur in developing countries. About half of these deaths occur at the most productive time of life, between 30 and 69 years of age.
Obesity and the diseases it causes lead typically to illness that increases over a number of years and ends in premature death.
In high-income countries chronic diseases place a heavy burden on the health care system, on health insurance, and on the employers and employees who pay the premiums.
Medical expenditure in the 1990s in the USA amounted to over $78 billion for diseases related to obesity and overweight. This reflects a doubling of the prevalence in obesity since the 1980s, to 30% of the adult population.
In addition to the direct medical costs, overweight has a wide range of other economic implications. These include work days lost to illness and disability, loss of productivity due to early death, and the vicious cycle of poverty caused by unemployment and low achievement at school.
In many developing countries the rise in diabetes, heart disease and stroke comes in addition to high levels of HIV/AIDS, tuberculosis and malaria. The double burden tends to make health systems doubly incapable of meeting the demands placed on them. This drives families deeper into poverty, with more catastrophic health costs, and declining life expectancy.
In sum, the main thing to know about obesity is that it is bad news for everyone, rich and poor alike, and it is getting worse.
Having said that, I will now tell you about the good news. The main thing everyone needs to be clear about is that obesity and the suffering it causes are preventable. Thanks to the CDC monitoring studies, we have carefully observed the emergence of the obesity epidemic in the USA. There is no reason why we should not also observe its eventual disappearance as people learn about its causes and the unnecessary harm it does.
The most effective way to tackle the issues of diet and physical activity is through population-wide initiatives. For too long, being overweight has been seen as primarily a matter of personal choice. It is true that individuals can do a lot, but they need the support of society, the environment, the market, the home, the workplace and the school. When they have to resist social and economic pressures in order to stay well, only a small minority of them will succeed. In addition to an independent spirit they need the means, the education and the skills to resist an obesogenic environment. That is why obesity is increasingly concentrated in the poor and deprived communities in all societies.
Children are particularly obviously in need of support. They are in no position to choose between lifestyles or to understand the consequences of their eating habits. They depend on the care and knowledge of adults. Being highly receptive, they are also easy prey for unscrupulous advertising. The poor likewise may have little choice in matters of what to eat or how to live. Even where people have several options, they need reliable information and moral support in order to choose the best one. To the extent that they are without education or the means to change their situation, they depend on the advice and choices of others.
Given these well-known realities of public health, the World Health Assembly adopted the Global Strategy on Diet and Physical Activity last year. It provides information and advice on cost-effective interventions that can reduce obesity and the other risk factors for chronic diseases. These interventions combine the expertise, capacities and resources of all concerned in improving diets and increasing physical activity. Where government, industry, trade, civil society and research institutions work together to find the best solutions, they can not only curb the epidemic of obesity but put an end to it.
The Strategy will be supplemented by a global report, Preventing chronic diseases: a vital investment, which is coming out in October. It will provide detailed information on the risk factors for heart attack, stroke, cancer, diabetes and other chronic conditions, the causes of these risks, and how to prevent them. It will then explain what this means for a realistic level of investment in prevention and control.
Our host country, Canada, has been a strong supporter of the global strategy. With its long tradition of leadership in health promotion, Canada has a lot to teach the world in this regard.
Health Canada's Summer Active programme provides excellent opportunities for promoting balanced diets and adequate physical activity. The Canadian Government's code of advertising to children helps to counteract the growing trend towards snacking on energy-dense foods and soft drinks. The requirement of nutritional labelling of all products is a valuable legislative approach that other countries would do well to follow.
In several countries, good use of existing knowledge has led to major improvements in life expectancy and quality of life. Death rates from heart disease have fallen by 70% during the last 30 years in Australia, Canada and the United Kingdom. That capacity for effective action needs to be focused now on the challenge of obesity, which is threatening these life expectancy gains.
We all have to work together on this — governments, industry, trade, the health professions and consumers. If we just pursue our separate agendas we will achieve very little and at high cost. Synergistic thinking and action that include all concerned is in everyone's interests.
Where necessary, of course, we have to resort to the law, as we did in the case of tobacco. But the struggle for a healthy diet is fundamentally different. No one needs to smoke and it is always harmful. Everyone needs to eat, and good nutrition contributes perhaps more than anything else to good health. Making that vital contribution is as good for the producers and suppliers as it is for the consumers. Likewise, failure to make it is bad for everyone in the long run.
So let us put our minds together here today to prevent the spread of obesity, and realize our potential for ensuring good health for everybody.