World Health Organisation publishes new report on overweight, obesity, diabetes and the law

Posted by Jenny Kaldor and Roger Magnusson

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This is the view when you look out the front gates of the World Health Organisation’s regional headquarters in Manila.

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A few blocks away, in the processed food aisles of the supermarket, parents are encouraged to purchase “nutrition power for kids”.

The Western Pacific Region, which includes Australia, is home to 138 million adults with diabetes, and includes a number of Pacific Island countries where more than one third of the population have diabetes, and around one half of the population are obese.  [See separate blog post]

In response to these issues in our region, Manila was the venue for a consultation on 9-11 April 2014, on overweight, obesity, diabetes and the law, co-hosted by the University of Sydney (Sydney Law School and the Boden Institute), and by the International Development Law Organisation (IDLO).  The consultation brought together public health practitioners, community leaders and academics from around the region, including Fiji, Singapore, New Zealand, Indonesia, Cambodia, South Korea, Mongolia, PNG, the Philippines and more.

The consultation was co-chaired by Professor Stephen Colagiuri (Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders), Professor Roger Magnusson (Sydney Law School), and Mr David Patterson (IDLO).  The background paper and meeting report were written by the rapporteur for the consultation, Ms Jenny Kaldor, who is a PhD candidate at Sydney Law School.

The Western Pacific Regional Office of the World Health Organisation (WHO – WPRO) was the co-sponsor and convenor of the consultation, and has just published the meeting report, which is available below:

WPRO CONSULTATION ON OVERWEIGHT OBESITY DIABETES AND THE LAW – 9-11A APRIL 2014 – FINAL REPORT – RS_2014_GE_66_PHL_eng.

The report illustrates the variety of legal issues that overweight, obesity and diabetes are causing for countries within the Western Pacific WHO region, as well as how law might be used to improve health outcomes.  These include the problems of diabetes-related disability discrimination, discrimination in access to diabetes medications, and good practices in legislation to improve food environments and opportunities for physical activity, from across the region.  The report discusses the opportunities for, and obstacles to, using law effectively, as well as the challenge of ensuring that trade agreements and trade laws do not work at cross-purposes to health policies on obesity and diabetes.

The meeting report highlights several important conclusions:

  • There is a strong need to build the evidence-base on legal interventions relating to obesity, diabetes and population diets.  Case studies, feasibility studies, guidelines, summaries and other tools can assist countries to share their knowledge and experience with legal and regulatory interventions.  Researchers and academics have an important role to play.  Networks need to be built across the region to better facilitate information sharing.
  • Developing local expertise in public health law and in particular, law related to obesity, overweight and diabetes, is a priority.
  • In-depth technical advice is needed on promising interventions.  These include a tax on sugar-sweetened beverages; restrictions on unhealthy marketing of food and beverages to children; requirements for interpretive, front-of-pack labelling; and legislation to create environments that facilitate and encourage physical activity.
  • Civil society has a vital role to play in the development, implementation and enforcement of innovative legal approaches to overweight, obesity and diabetes.
  • Addressing the interference of the food and drinks industries in policy development and implementation in countries across the region is a priority.  Clear guidelines are needed to avoid conflicts of interest and to ensure that government interactions with the food industry are transparent and constructive, and do not jeopardise public health goals.
  • Law needs to be better integrated into the agenda of the World Health Organisation.  Law is central to advancing the goals of WHO, and can enable countries to protect, respect and fulfil the right to health.

Does Coca Cola have a role in delivering Pacific aid?

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Posted by Roger Magnusson and Alexandra Jones

The Foreign Minister, The Hon. Julie Bishop MP has announced that Australia will partner with companies like Coca-Cola to distribute essential medicines to Pacific Island recipients of Australian aid.

The Minister is right about one thing: tobacco and fizzy drink companies have strong distribution networks that reach into the remotest parts of low income countries around the world.  And they would welcome the legitimacy that comes from “being part of the solution” – from “helping to save lives”.

But conflict of interest looms large.  In some islands of the Pacific, more than a third of the population have diabetes (See the table at the bottom of this post, drawn from a recent paper on non-communicable diseases (NCDs) in the Pacific.  The table is worth reproducing in full, since it illustrates just how bad everything is). Combined rates of overweight and obesity among men and women in some Pacific island recipients of Australian aid reach or exceed 80%.  In some countries obesity rates alone exceed 45% (in Tonga, the rate of obesity in men and women > 20 years is 59.5%).  Do these countries really need Coca Cola?

There might well be novel ways of partnering with the private sector to improve aid performance.  Results matter: the Minister is absolutely correct on this point.  But this applies at home as well.  For example, under-performing public health initiatives such as the stalled Food and Health Dialogue – which was supposed to deliver a healthier food supply with less salt and saturated fat – also need to be overhauled.  (A recent paper by Roger Magnusson and Belinda Reeve illustrates how “regulatory scaffolding” could be used by government to strengthen the performance of this vital initiative while minimising the need for direct, statutory regulation).

In Pacific Island Countries and Territories, partnering with the multinationals that are driving risk factors for obesity and diabetes makes no sense.  Australian Aid wouldn’t partner with a tobacco company like Philip Morris, so why partner with a fizzy drink company selling empty calories to some of the most obese and diabetic countries in the world?

Unlike, say, Unilever, which can diversify into healthier products and create healthier brands, Coca Cola and Pepsico have a real problem: their leading brands are soft drinks.  It would be economic suicide to sacrifice the full-sugar variants, and yet this colours every positive contribution they might otherwise seek to make to development or public health.  People who want to move towards a healthier weight – not to mention better dental health – need less soda, not more, and yet reducing consumption is bad for profits.  Suffice it to say that Coca Cola would surely be delighted at the prospect of becoming integrated into the public health infrastructure in these fragile island states.

It’s worth asking: just how did Coca Cola get inside the Minister’s head?  Why is its name bobbing up now?

At the Joint Forum Economic and Pacific Health Ministers Meeting in Honiara in July 2014, Economic and Health Ministers from Pacific Island Forum countries agreed that non-communicable diseases (NCDs) are ‘financially unsustainable’.  They committed to develop country-specific roadmaps covering the following five priorities (Joint Economic Forum and Pacific Health Ministers Meeting 2014). These priorities are:

    • Strengthening tobacco control;
    • Considering an increase in taxation of alcohol products;
    • Reducing consumption of unhealthy food and drink;
    • Improving efficiency of existing health expenditure; and
    • Strengthening the evidence base to ensure optimal use of resources.

These commitments take place against the background of the World Health Organisation’s Western Pacific Regional Action Plan on NCDs  and the World Bank’s NCD Roadmap Report.  Both documents identify “best buys” and other policy priorities that countries should adopt in order to reduce death and disease from NCDs.

Let’s be honest here: the commitments of Joint Economic Forum and Pacific Health Ministers are not only a business risk to Coca Cola, but to tobacco multinationals and other junk food and beverage companies that operate in the region.  Other risks loom on the horizon.  For example, the World Health Organisation has established a Commission on Ending Childhood Obesity, which has already released an interim report which identifies a number of policy options for reducing intake of unhealthy foods and non-alcoholic beverages by children.  The Commission is holding a hearing in Auckland for the Western Pacific Region within the next few weeks.

Is Coca Cola really part of the solution?  If you have any lingering doubts, just ask a dentist.

Readers may also be interested in a recent paper by Jenny Kaldor and Roger Magnusson (from Sydney Law School) and from Stephen Colagiuri (from the University’s Boden Institute of Obesity, Nutrition Exercise, a WHO Collaborating Centre) on how law and regulation could contribute to efforts to wind back Australia’s epidemic of diabetes.

Selected risk factors for non-communicable diseases in Pacific Island Countries and Territories, compared to Australia 

Obesity rates % (2013)a
Country Men>20 years Women >20 years Men & women >20 years
Kiribati 39 56 47.5
Samoa 46 69 57.5
Tonga 52 67 59.5
Australia 28 30 29
Smoking prevalence % (2011)b,c
Country Men >15 years Women >15 years Men & women> 20 years
Kiribati 67 37 52
Papua New Guinea 55 27 41
Solomon Islands 45 18 32
Tonga 43 12 28
Australiad   18 14 16
Diabetes prevalence % (2013)e,f
Country Total adult population
Cook Islands 26
Federated State of Micronesia 35
French Polynesia 22
Kiribati 29
Marshall Islands 35
Nauru 23
Tokelau 38
Vanuatu 24
Australiag 4

a Statistics sourced from Ng M, Fleming T, Robinson M, et al (2014) Global, Regional and National Prevalence of Overweight and Obesity in Children and Adults During 1980-2013: A Systematic Analysis for the Global Burden of Disease Study 2013. Lancet 384, 766-781.

b Statistics sourced from World Bank (n.d.) World Development Indicators: Health Risk Factors, viewed December 2014 <http://datatopics.worldbank.org/hnp/HNPDash.aspx&gt;.

c Statistics for Australia sourced from Australian Bureau of Statistics (ABS) (2012) Australia’s Health Survey: First Results, 2011-2012, Tobacco Smoking. 4364.0.55.001, 29 October 2012, viewed December 2014  <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/73963BA1EA6D6221CA257AA30014BE3E?opendocument&gt;.

d Australian data are for daily smoking rates among adults aged >18 years, for 2011-2012.

e Statistics sourced from Chan J, Cho N, Tajima N, Shaw J (2014) Diabetes in the Western Pacific Region – Past, Present and Future. Diabetes Research and Clinical Practice 103, 244-255.

f Statistics for Australia sourced from ABS (2012) Australia’s Health Survey: First Results, 2011-2012, Diabetes Mellitus. 4364. 0.55. 001, 29 October 2012, viewed December 2014 <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/D4F2A67B76B06C12CA257AA30014BC65?opendocument&gt;.

g Australian data are for the period 2011-2012.

As part of its Master of Health Law program, Sydney Law School offers several units of study that consider global health, law and development.  These include Critical issues in Public Health Law; Law, Business and Healthy Lifestyles; Global Health Law; and Trade Regulation, Health and the Environment.

[Thanks to Alexandra Jones for references and for information about Australia’ health aid program]