Health as if everybody counted blog
Our big fat complicated population health problem, Part 2: It may be worse than we thought
Few now dispute the importance for population health of the rapidly rising prevalence of overweight and obesity, in countries rich and poor alike. What to do about it is a matter of greater dispute. An accumulating body of evidence suggests, as Rob Moodie and colleagues argued earlier this year in The Lancet, that overweight and obesity should be regarded at least in part as an “industrial epidemic” in which “the vectors of spread are not biological agents, but transnational corporations” like those that dominate the food and drink industries.
In this vein, an important exposé in the November-December 2012 issue of Mother Jones tried to answer the question of how the sugar industry “kept scientists from asking: Does sugar kill?” The authors obtained documents dating back to 1942 describing the industry’s use of a strategy that David Michaels, a former senior official of the US government, has called “manufacturing uncertainty”. The strategy was perfected by the tobacco and asbestos industries, but has been applied far more widely to resist regulation and other policy interventions aimed at protecting public health. On March 20, The Guardian reported on a series of talks given in Britain by Robert Lustig, an endocrinologist who argues that: “The food industry has made [sugar] into a diet staple because they know when they do, you buy more.” This point is of special importance because of the continuing insistence, notably in the documents supporting and emanating from the UN High-level Meeting on Non-communicable Diseases, that public-private collaborations can contribute meaningfully to prevention of such conditions as cardiovascular disease and diabetes. And evidence is accumulating that fructose, in particular, has destructive effects that go beyond its direct contribution to excessive caloric intake – a point that was emphasized during a panel on sugary drinks I recently attended at the 15th Public Health Research Conference at Mexico’s impressive National Institute of Public Health.
As noted in an earlier posting, rising overweight and obesity represent a complex problématique that cannot be isolated from issues of political economy, health equity and social justice. On the political economy front, a fascinating recent open-access article on “exporting obesity” argues that the combination of farm subsidies in the United States and the removal of trade and investment barriers between the US and Mexico under the North American Free Trade Agreement led to rapid transformation of the Mexican “consumer food environment” in several unhealthy ways. One of these involved a dramatic increase in US exports of (subsidized) corn to Mexico, partly in the form of high-fructose corn syrup (HFCS) following a 2006 World Trade Organization ruling against a Mexican tax on soft drinks sweetened with anything other than cane sugar. Pediatric obesity researcher Michael Goran, one of the panelists at the Mexican meeting, has made a similar point. These exports have, in turn, no doubt contributed to a prevalence of obesity in Mexico that is actually higher among adults than in Canada. So, too, has the rapid transformation of the Mexican food system through foreign direct investment.
On the social justice front, an article written by Goran and colleagues, including the Director of Health Assessment and Epidemiology for Los Angeles County’s Department of Public Health, demonstrates a pronounced socioeconomic gradient in the prevalence of childhood and adolescent obesity in the sprawling county, “with a striking fourfold difference in childhood obesity prevalence between the communities with the highest and lowest levels of EH [economic hardship].” Equity concerns have often been left aside in discussions of how best to deal with overweight, obesity, and their health consequences. This finding underscores the urgency of addressing not only the challenges presented by corporate interests in the food industry but also such issues as economic deprivation, access to and affordability of healthy diets, and disparities in access to safe options for physical activity as part of any comprehensive approach to the problem.