Engaging with the Private Sector on Chronic Disease Risks
WHO Global Strategy on Diet, Physical Activity and Health between WHO and CEOs from the Food, Beverage, Physical Activity and Insurance Industries
At last year’s World Health Assembly, I said I would be inviting the key players in the food industry to work with WHO in addressing the enormous challenge posed by the rising incidence of chronic diseases, especially in developing countries. I would like to welcome you all most warmly to WHO. We appreciate the interest and commitment you have shown in coming here today.
This historic meeting builds on many successful interactions over several years, on issues ranging from food safety to undernutrition. It formally begins what we hope will develop into an ongoing and constructive high-level dialogue with private sector companies. Today’s goal is simple; to see how we can work together to address the enormous challenge posed by the growing toll of death and disability from chronic diseases.
Our world is in transition. Globally, societies are becoming more urbanized, populations are ageing, physical activity levels are declining. We have seen a major shift away from traditional diets, and the increased consumption of energy-dense diets with high levels of fats and sugars, as well as salt. At the same time, the consumption of fruit and vegetables is going down. As a result of all these factors, as well as tobacco use, the global profile of disease is changing. Cardiovascular disease, cancers, diabetes, respiratory disease, obesity and other noncommunicable conditions now account for approximately 60 per cent of the 56.5 million global deaths annually.
WHO, in response to Member State concern, has made this a priority global public health issue. The evidence of the changing disease burden is clear. The evidence on the risk factors is clear. And the evidence about effective preventive measures is equally clear. This month’s World Health Assembly will see the adoption of the WHO Framework Convention on Tobacco Control, which will lead to increased focus and attention on one major chronic disease risk, tobacco. We are now actively addressing two other major risks: unhealthy diet and physical inactivity. Why are we talking with the private sector? Because we believe that companies such as yours can make a major contribution towards easing this burden and promoting healthier diets and lifestyles. Food is not tobacco. We wish to work with companies like yours. We want to hear what you need from us, as well as to tell you what we are planning. We have to ensure that, on a global basis, healthy choices become easy choices for our constituents, and your consumers.
The Global Chronic Disease Burden
Chronic diseases are now the major cause of death and disability worldwide. Noncommunicable conditions now account for 59 per cent of the 56.5 million deaths annually and almost half, or 45.9 per cent, of the global burden of disease. And these are no longer rich country diseases; the majority now occur in developing countries. One example, which makes this point very graphically, comes from China. In the rural areas, noncommunicable diseases now account for more than 80 percent of deaths; communicable diseases, less than three percent. Cardiovascular disease now accounts for almost one in three premature deaths worldwide. And cardiovascular diseases are even now more numerous in India and China, than in all economically developed countries in the world added together.
Five of the top 10 global disease burden risk factors identified by World Health Report 2002: reducing risks, promoting healthy life – high blood pressure, high cholesterol, obesity, alcohol and tobacco – independently and often in combination, are the major causes of these diseases. It is important to note that this is not simply an obesity issue; high blood pressure and high cholesterol caused by unbalanced diets can exist regardless of the patient’s weight. World Health Report 2002 examines current deaths/disease data and reflects the impact of risk factors over the last decade or so. But current risk levels predict major increases in chronic diseases, unless we take action now.
WHO/FAO Diet Report
Last month, the Joint WHO/Food and Agricultural Organization Expert Consultation report, Diet, Nutrition and the Prevention of Chronic Diseases, was formally issued in Rome by FAO Director-General Jacques Diouf and myself. This Report, chaired by Professor Ricardo Uauy – who is with us today – contains the best currently available scientific evidence on the relationship of diet, nutrition and physical activity to chronic diseases. It also highlights the enhanced cooperation between WHO and FAO for the greater public good.
The Report addresses cardiovascular diseases, several forms of cancer, diabetes, obesity, osteoporosis and dental disease. It emphasizes that a diet low in saturated fats, sugars and salt, and high in vegetables and fruits, together with an increase in physical activity, will have a major impact on this high toll of death and disease.
The Expert Report’s recommendations include limiting fat to between 15 and 30 percent of total daily energy intake, and saturated fats to less than 10 percent. It suggests that carbohydrates should provide the bulk of energy requirements – between 55 and 75 percent of daily intake, but that free sugars should remain beneath 10 percent. People should restrict their daily intake of salt to less than five grams a day. They should eat at least 400 grams of fruit and vegetables every day. It also notes that, ideally, people should spend one hour on most days of the week engaged in moderate-intensity activity, such as walking, to maintain a healthy body weight.
We are now in a strong position to advise our Member States on the current state of nutritional science relating to chronic diseases. We will be using this report as the critical science-based foundation for the Global Strategy on Diet, Physical Activity and Health which we are currently preparing. .
But to effect these changes poses an enormous challenge. National action by governments is an important starting point, and can be very effective. But in an increasingly globalized and interdependent world, we believe WHO’s goals can only be met through broader, multi-level and multi-sectoral involvement with diverse stakeholders.
Global Strategy The Global Strategy on Diet, Physical Activity and Health comes in response to our Member States’ concerns. The Fifty-third World Health Assembly in May 2000 adopted a resolution endorsing a Global Strategy for prevention and control of noncommunicable diseases (WHA 53.17). The strategy emphasized integrated prevention by targeting three main risk factors: tobacco, unhealthy diet and physical inactivity. We have already moved vigorously on the health threat posed by tobacco. Then, in May last year, the Fifty-fifth WHA approved a new resolution requesting the Director General to develop a Global Strategy on Diet, Physical Activity and Health (WHA 55.23) for presentation to Member States in May 2004.
Significantly, the WHA asked us to develop this strategy in consultation – not only with Member States and UN agencies – but in collaboration with the private sector and civil society. WHO is now engaged in a wide-ranging process to prepare the Global Strategy, which involves broad consultation. Which is why we are here today.
The Strategy Process
Let me explain the strategy process. Phase One focused on assembling and compiling evidence on the extent of the problem and possible solutions. Today’s meeting is part of Phase Two, which includes wide multi-level consultation. We will be meeting later this month with civil society groups. And in June, we have consultations scheduled with UN agencies and industry trade associations.
Our Member States are key. As part of the process to gather their input, we have held five of our six regional consultations. Our meetings so far have reaffirmed, both the importance of what we are doing, and the range of different problems countries face. For example, in Harare, our colleagues from Africa stressed to us that while under-nutrition and food security remain key problems, diet-related chronic diseases co-exist and are on the rise. And Africa is the only one of our six regions where infectious diseases still dominate – for our other five regions, chronic diseases are the major killers.
At our South East Asia Region meeting in New Delhi, for example, we heard that in some urban areas of India, from one-quarter to one-third of the population is overweight. They told us that many countries are suffering from a double burden – of undernutrition, but also of the consequences of a rapid transition to unbalanced diets and overeating. Most developing countries simply do not have the resources to deal with the growing burden of chronic disease on top of their existing health problems.
In Costa Rica, our Pan-American members noted the need to increase the availability and access to healthy foods through multicultural policies and alliances. They also emphasized the need to address the issue of marketing and improve food labelling through joint action by regulatory agencies, private sector and consumer groups.
European Member States concluded that agricultural, transport and community planning policies needed to take into account public health goals, and that health impact systems should be set up to assess evidence and inform the decision-making process.
Once this consultation process concludes, we will focus on drafting the strategy, with guidance from our expert reference group, chaired by Professor Kaare Norum, who is also with us today. The Strategy will be presented to our Executive Board in January 2004, but a draft will be made available for comment by all stakeholders before the end of the year. We are making this process as transparent and inclusive as possible.
But formulating a strategy does not mean that we have solved the problem. We want to create a momentum behind the strategy so that it works in practice to better the health of people worldwide. Which is why we need your early input and sustained support.
Experiences of WHO-Private Sector Interaction
WHO's work in the past few years on TB, Malaria, AIDS and on Risks to Health, have all reinforced the usefulness of developing relationships with the private sector. We realize that effective multi-stakeholder involvement can amplify our public health agenda. We have seen several private-public partnerships established, such as the Global Alliance for Vaccines and Immunization, the Medicines for Malaria Venture, International AIDS Vaccine Initiative, as well as WHO collaboration with the IOC and FIFA on tobacco control, Roll Back Malaria, Vision 2020 and many other campaigns.
Perhaps our most frequent private-sector interaction has been with the pharmaceutical industry. This ranges from industry commenting on WHO policies and documents, to establishing practical partnerships on certain campaigns or the development of certain medicines, through to an established mechanism for an ongoing dialogue - the Director General's Roundtable with pharmaceutical CEOs – the model for our meeting today.
However, as I think you would agree, we need to abide by some key principles in these relationships. WHO interactions with the private sector should, primarily, be about promoting health. We have to safeguard the integrity of the policy-making process to protect ourselves from real or perceived conflicts of interest. Our interaction must be transparent and accountable. And, of course, WHO does not endorse companies or products.
But we do want to find ways to welcome efforts by companies to align their actions with WHO’s policy guidelines. We also understand that companies need a predictable regulatory environment, and one which provides incentives to develop foods that meet the nutrient goals recommended by our experts.
Some Common Ground
So what do we have in common? And where do we have differences?
We both have self-interests in the health and well-being of the public. You want them as customers to come back to your restaurant, or into the supermarket, and purchase your products and services. For that, people must be healthy, and need to trust that none of the products consumed will harm their health. There are some issues on which I doubt we have much disagreement. We need more fruits and vegetables in the diet. We advocate much more physical activity. We think everyone should be encouraged to see the health advantages of maintaining a normal body weight.
There have been some encouraging initiatives. Many food companies have already introduced products with low or even no fat, with no or low sugars, with low salt. Some supermarket chains have joined the "5-a-Day" partnership to aggressively promote fruits and vegetables; others are campaigning for the use of healthier, low cholesterol edible oils. Both food companies and supermarkets can play a key role in the area of shifting public taste. Many companies in the food, insurance and sports sectors are already sponsoring and promoting physical activity, through facilities and awareness.
And, of course, consumer demand is influenced by new science and knowledge coming from the public sector, which now explicitly emphasizes the need for better nutrition and more physical activity. We would expect this to stimulate increased demand for new food products.
All of this is extremely important. But, there is a need for much more, for three main reasons. First, the health problems are truly devastating, especially in poorer communities and countries, and will get much worse if we do not act now. Second, because a lot more can be done and your companies have the capacity to begin leading that change right now. And, third, because change will ultimately benefit everyone, most importantly, the health of our constituents; your consumers.
More Difficult Issues
And then, there are the more difficult issues. We would like food companies in some countries to promote smaller portions. We would like to see real moves to cut the amount of fat, sugars and salt in foods. We think consumers have a basic right to know what they are eating and the effects it can have on them. That means clear, informative, accurate and scientifically proven labelling of food products’ benefits or potential harmful effects personal choice has to be made in an environment in which consumers are fully informed. And we want food companies to reassess what they are marketing to young children, and how they are going about it.
Governments have a key leadership role in developing the regulatory and economic environment needed to allow people to make healthy choices and to stimulate markets to promote health. However, our Member States have made clear during their consultations with us, that the chronic disease problems are so serious they will require joint collaboration with the food industry. And they are asking for WHO’s guidance on how to manage that interaction.
We know that these are difficult issues to navigate. We know they will take time. We know that we will often disagree on the best way forward. We understand that in the end, decisions about the sorts of food you make, come down to issues of taste, convenience and profitability. We also appreciate that the ability to market your products effectively is fundamental to the process of capital formation. However, we believe that your products should reflect your overall commitments to corporate social responsibility. I believe that the time has come to review how health considerations could be incorporated to existing Corporate Social Responsibility initiatives such as the Global Compact along side labour, environment and human rights.
When products are neutral, or beneficial in their effects, there is no problem. But if, as was the case with tobacco, the product is lethal in itself or is engineered to addict, we have to act. Food is not tobacco, but the evidence is clear that harm can follow excessive use of certain constituents of modern diets.
WHO is advocating a strategic shift; first in advocating that nutrition and food issues need to be firmly integrated into overall national health policies. And second, in our willingness to interact constructively with food-related industries on these issues. We believe that calling for a reduction in the amount of saturated fats, sugars and salt in the diet – and for a marketing environment where the health and well-being of consumers is explicitly protected and promoted – is viable from a business point of view.
I am encouraged by new forms of global private-NGO-consumer initiatives to promote public goals, such as the Forest Stewardship Council. The issue of marketing and children could perhaps be addressed through such an approach.
We asked you here because we wish to learn from your experience, and to get your feedback on what you believe to be achievable. Today’s discussion provides an excellent opportunity to launch our dialogue process. The work we are embarked upon could lead to one of the largest positive shifts in population health ever undertaken. We welcome your participation and look forward to your input.