Fanzo: The need to better formulate healthy food policies

By Jessica Fanzo/Bloomberg View

The food that people eat has become a major risk factor for disability and death worldwide. Yet countries and their philanthropic supporters seem not to be paying attention. They're investing far too little in improving diets and preventing nutrition-related disease.

The problem is part of a larger trend in human mortality. Until recently, in many low- and middle-income countries, malaria, diarrhea and other infectious diseases were the biggest killers. While such illnesses are far from being eradicated, noncommunicable diseases such as cardiovascular disease, diabetes and cancer have become more widespread, and now account for two out of every three deaths globally. Seventy-five percent of these deaths occur in low- and middle-income countries.

Why has this happened? Lifestyles have changed and, with them, diets. The world's growing population is more urban and global, and many countries, though not all, are improving economically. Over the past few decades, there's been an exponential increase in the number of people who are overweight or obese, and thus more vulnerable to noncommunicable diseases. A staggering 2 billion people are now overweight or obese, including 41 million children under the age of 5. To make matters worse, two-thirds of those children reside in low- and middle-income countries.

In certain ways, to be sure, people are eating better. Consumption of fruits, vegetables and nuts has increased in some regions of the world. But there has also been a marked shift toward the unhealthy. Ever more popular "western" diets are heavy on foods high in sugar, unhealthy fats and sodium; salted or cured meats; and overly processed junk food - accompanied by sugar-sweetened beverages. Such diets tend to include few of the most healthful foods: fresh fruits and vegetables, nuts and seeds, lean meats, seafood rich in omega three fatty acids, legumes and fibrous whole grains. And research shows that all dietary habits - whether Mediterranean, pescatarian, vegetarian, omnivorous, or plain unhealthy - matter to people's well-being and survival.

When people's diets are bad, health systems pay the price in the form of increased treatments for noncommunicable diseases. From 2010 to 2025, this economic burden is expected to add up to $7 trillion, with most of the money going to cardiovascular disease. Improvements to food systems could go a long way toward defraying that cost, but investments in such change are not living up to the challenge. Global spending by donors on diet-related diseases amounts to only about one-tenth of 1 percent of overseas development assistance.

To begin to lighten this burden, countries need to start to shift lifestyles and strengthen food systems. They can employ proven strategies to persuade their citizens to eat better, reduce alcohol and tobacco use, and increase physical activity. For example, in Chile, front-of-the-package labels let consumers know which foods contain a lot of fat, sugar or salt, and such foods cannot be sold in schools or advertised on television to children under the age of 14. Taxes on soda or junk food, mass media public-education campaigns, improved dietary guidelines, and subsidies to ensure that nutritious foods are affordable can all lead people to make healthier dietary choices. In Mexico, a soda tax has led to a significant drop in soda consumption.

Countries also need to improve surveillance of healthy behaviors and noncommunicable diseases, even as they make essential medicines and medical technologies and treatments more widely available. Governments need to strengthen connections between food systems and health systems, including by formulating healthy food policies. For example, the Greater Philadelphia Region is planning food-system investments aimed at improving food security and combating obesity.

Governments and private donors need to increase their investments in both health and agriculture sectors, and work together to lower the risk of diet-related illness and death.

- Jessica Fanzo is a Bloomberg Distinguished Professor of global food and agricultural policy and ethics at the Nitze School of Advanced International Studies, the Berman Institute of Bioethics and the Department of International Health of the Bloomberg School of Public Health at Johns Hopkins University.

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