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Health as if everybody counted blog

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More on diet and population health

Posted by Ted Schrecker
Ted Schrecker
Ted Schrecker is a clinical scientist at the Élisabeth Bruyère Research Institut
User is currently offline
on Tuesday, 08 January 2013
in CHNET-Works!

A recent posting featured two important research syntheses on overweight and obesity. Another, especially useful for non-specialist audiences, appeared as a special report on “The big picture” in the December 15 issue of The Economist.

Commendably, the report does not sugar-coat the difficult politics of reducing overweight and obesity. It notes, for example, that “while lots of people remain fat, the associated ailments represent big business for the drug companies.”  It is candid about the role of companies like soft-drink manufacturers and fast-food chains in contributing to the epidemic of overweight, and the conflicts of interest that can arise in partnerships like one between Nestlé and the International Diabetes Federation, or the “Responsibility Deal” between food and alcohol companies and Britain’s Department of Health. (In negotiations about the action plan that emerged from the UN Summit on non-communicable diseases in September 2011, Canada was among the countries pressing for removal of text that mentioned such conflicts.) And it presents a succinct overview of efforts to deal with overweight and obesity through taxation and regulation. So far, those efforts have met with modest success, although that may be a consequence of modest ambition rather than of limitations intrinsic to the available policy instruments.

Unfortunately, the report is not open-access, although non-subscribers will be able to read part of it online. Unfortunately as well, the report pays insufficient attention to connections between the built environment and overweight, or to the cost of a healthy diet. Nevertheless, it is a refreshing signal that approaches going beyond the usual health promotion nostrums are moving into the policy mainstream.

Shortly before the Economist report appeared, Britain’s Department of Environment, Food and Rural Affairs released its annual Family Food Survey for the year 2011. Among the survey’s disturbing findings: fruit and vegetable purchases were 10 percent lower in 2011 than in 2007, with an even larger decline among the bottom fifth of Britain’s income distribution. Households in the lowest tenth of the income distribution were spending 17 percent more on food in 2011 than in 2007. A report in The Guardian quoted the director of the consumer protection organization Which? as saying: “One in six people say rising food prices are making it difficult to eat healthily,” and the preceding month a report in the same newspaper warned of a “nutrition recession” - this in a country where benefit caps planned for 2013 will cut the incomes of many people in full-time jobs as well as those who cannot find work. 

Closer to home, Ottawa's deparment of public health released the lastest issue of an annual calculation showing that if you are living on social assistance and paying market rents in the city, it is arithmetically impossible - as it is much of the rest of the province- to pay for the diet recommended by Ontario's Public Health Standards. In the capital of a weathly G7 country, 48,000 people a month turn to food banks. Against the background of ongoing concern about health care spending and areport recommending an immediate increase in Ontario social assistance rates to " the lower rate category, single adults receiving Ontario Works, as a down payment on adequacy while the system undergoes transformation," it may be worth asking`just how does making healthiy diets unaffordable contribute to a healthier population and lower health system costs down the road?

Food security: Canada gets a warning

Posted by Ted Schrecker
Ted Schrecker
Ted Schrecker is a clinical scientist at the Élisabeth Bruyère Research Institut
User is currently offline
on Thursday, 17 May 2012
in CHNET-Works!

Olivier De Schutter, the second United Nations Special Rapporteur on the Right to Food, is one of the most thoughtful thematic mandate holders, as they are called in UN-speak. (There are currently 36 such mandates.) His reports and commentaries provide articulate critiques not only of the policies of specific national governments, but also of an international agri-food system that is conspicuously failing to protect and fulfil the right of all to an adequate diet – one of the most basic social determinants of health.

The preliminary report of Prof. De Schutter's mission to Canada, which wound up on May 16, is sobering reading for a country that is often prone to self-congratulation on its human rights record. He points out that according to the 2004 Canadian Community Health Survey, 7.7 percent of Canadian households reported moderate or severe food insecurity – this before the financial crisis of 2008 and subsequent recession – and "was disconcerted by the deep and severe food insecurity" faced by aboriginal people, the legacy in part of a "long history of political and economic marginalization."

de-schutter-pic-1UN Photo/Jean-Marc Ferre.
Reproduced under Creative Commons Licence 2.0.
His report directly links food insecurity and increasing reliance on food banks to low incomes and the high cost of housing – a link that has been referred to in earlier postings. "In the view of the Special Rapporteur, social assistance levels need to be increased immediately to correspond to the costs of basic necessities," and minimum wages should be set at a living wage level as required by the International Covenant on Economic, Social and Cultural Rights, to which Canada is a state party.

Population health researchers have effectively documented the extent of food insecurity in Canada; the work of the University of Toronto's Valerie Tarasuk is especially powerful in this respect, as are the reports of the Toronto Department of Public Health. We have perhaps not taken advantage of opportunities to frame food security as a human rights issue, a matter of priorities. Maybe food security for all is just more important than freeway widenings or fighter aircraft ... or maybe we don't even need to make those choices. Prof. DeSchutter pointed out that: "The tax-to-GDP ratio of Canada ... is now in the lowest third of OECD countries. Consequently, Canada has the fiscal space to address the basic human needs of its most marginalized and disempowered." I've made a similar observation in a previous posting.

Predictably, the official response was less than cordial. Cabinet minister Jason Kenney, at roughly zero risk of food insecurity, referred to "lectures to wealthy and developed countries" as "a discredit to the United Nations." He might want to have a talk with Department of Justice lawyers about the nature of obligations under human rights treaties, but that's a topic for another day. Clearly, Prof. De Schutter's intervention gives a boost to those who would address the politics and priorities that deprive people in such a "wealthy and developed country" of food security.

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