PHM-Exch> UN Summit on non-communicable diseases: How to improve the current draft Political Declaration

[Claudio Schuftan]

UN Summit on non-communicable diseases How to improve the draft Political
Declaration

As stated, the draft Political Declaration on the prevention and control of
non-communicable diseases that follows, is developed from the Zero Draft
document at the end of this story, shown as Box 3.

Here follow comments and proposals for revisions of the draft Declaration.
Readers who are in support or who are sympathetic should make their own
contributions in the form of proposed track-changed amendments to the text
of the Declaration, in the form shown in the draft below.

It is appropriate to preface comments and proposals to the Declaration with
many thanks to the members of the UN Secretariat. They are doing their best
with grossly inadequate human and material resources. They are also under
intense pressure from commercial and other powerful interested parties whose
policies and practices are not in the public interest.

Indeed, some of the general and introductory points made are progressive.
These include explicit reference to prevention as being the first and
foremost strategy; to the social, economic and environmental determinants of
disease, health and well-being; to the need for 'whole-government' public
health strategies involving all relevant ministries; to the need for all
non-government actors to be fully and appropriately engaged; and (this is
rather muted) to deepening inequity between and within member states. You
will support the Secretariat by showing in the text that you support these
and other rational and progressive points, and wish them to be stressed.

The comments and proposals here summarise those that have been received or
discussed from various organisations and individuals. A substantial number
of them are supportive of comments and proposals made by the NCD
Alliance<http://www.wphna.org/downloadsaug2011/NCD%20Summit%20NCD%20Alliance%20asks.pdf>,
or by IASO/IOTF<http://www.wphna.org/downloadsaug2011/NCD%20Summit%20IASO-IOTF%20asks.pdf>,
whose own 'asks' are linked here.

*General points *

*1    Obesity needs to be identified as a non-communicable disease*
Much of the draft Declaration, and the whole initiative, is so far weakened,
and even vitiated, by obesity not being defined as a disease, as it is by
WHO in its reports and strategies, and in the International Classification
of Diseases. Obesity is not merely a 'risk factor' or 'marker' for other
diseases, it is a pathogenic condition in itself. Rates of obesity,
including in childhood and early life, together with the very closely
related disease of diabetes, now amount to an uncontrolled pandemic. *Obesity
should be bracketed with diabetes, cardiovascular diseases, relevant
respiratory diseases, and cancer, throughout the Declaration*

*2    Rational policies require quantification to become effective actions*
Much of the language in the draft Declaration is appropriate and
progressive. But almost all of it is in general terms, and could have been
drafted by bodies whose interests conflict with those of public health, as
'warm words' – lip-service. Policies and actions, to be effective, need to
be grounded. WHO has prepared a document including time-based targets but
this is not included or referred to in the
Declaration<http://www.wphna.org/downloadsaug2011/twg_targets_to_monitor_progress_reducing_ncds.pdf>.
*The Declaration, and also further annexed documents that are needed, need
to include quantified time-based goals and targets for relevant dietary
patterns, foods, products and nutrients, and for the prevention, control and
reduction of relevant diseases. These should be expressed in the form of
ranges, to allow for different circumstances, should be made binding by
member states on industry, and should be independently monitored. *

*3    Protection and improvement of public health always involves the use of
law*
There is occasional reference in the draft Declaration to statutory legal
and fiscal regulation of the types used to control use of tobacco and
consumption of alcohol, but only as one possible option to improve food
systems and dietary patterns. This is not a mere option, it is obviously now
essential. Subsidies that make unhealthy foodstuffs and products
artificially cheap should be removed. The advertising and marketing of
energy-dense or sugared food and drink products to children, in the media
and at or near school should be prohibited. *All relevant clauses of the
Declaration need rephrasing to make statutory instruments an invariable and
integral part of international and national strategy.*

*4    The role of conflicted industry needs to be limited*
In the draft Declaration, the terms 'private sector' and 'industry' require
definition. Examination of the document and experience of other UN
processes, indicate that the terms as used, actually do not refer to
industry as a whole, or even to the food and drink industry as a whole. They
evidently refer mainly to transnational and other very large food and drink
processors, distributors and caterers, whose commercial success currently
depends on very heavily promoted 'fast' or 'convenience' ultra-processed
energy-dense, fatty, sugary and/or salty products, which are damaging to
public health. *That part of the food and drink industry whose policies and
practices conflict with the interests of public health should, in the
Declaration, and in the whole NCD Summit process, not be identified as
partners in policy formulation, but solely in policy implementation. *

*5    Early life exposures are the most crucial *
Evidence that the pathogenic processes that lead to clinically evident NCDs
begin early in life, including before birth, is now conclusive. This
evidence is underscored by the explosive and uncontrolled rapid increase of
childhood and early life overweight, obesity, and diabetes, since the 1980s
in high-income countries, but which is now pandemic. The NCD Summit
therefore has a unique opportunity to initiate a profoundly important new
departure in public health. *All relevant items in the Declaration should be
drafted so as to give the highest priority to early life. Greater stress
needs be given to breastfeeding, the quality of weaning food, the marketing
of food to children, to school meals, and to the nutrition of young women.
The Declaration should emphasise that public authorities have a
responsibility to use law in order to protect the health, welfare and
well-being of children and of young women before and during pregnancy.*

*More specific points *

*6    Traditional food systems need emphasis and protection *
Traditional food systems, when these result in secure, adequate and varied
dietary patterns, are generally healthy. They are also appropriate and
beneficial socially and culturally, by their nature are derived from plant
and animal sources that are suited to local climate and terrain, and support
local economies. They are fundamental to the livelihoods of millions of
family and small farmers in lower-income countries. Examples are the
traditional diets of China, India, Thailand, the Mediterranean basin,
Mexico, Central America, and Brazil. The draft Declaration mentions
indigenous food systems, normally taken to mean those of First Nations, but
not traditional diets. *The Declaration should bracket traditional with
indigenous food systems as needing protection and support, and should give
examples as indicated here. *

*7    Fresh and minimally processed food needs promotion*
It has been agreed for decades that population health is protected by
dietary patterns made up from meals, dishes and foods that are relatively
high in a variety of whole and minimally processed grains (cereals), legumes
(pulses), vegetables and fruits, and other foods that are rich or good
sources of dietary fibre, essential fats, vitamins, minerals and other
bioactive compounds. But the draft Declaration makes no explicit reference
to the nutritional value of fresh and minimally processed foods. Indeed, it
makes no reference to meals and almost no reference to foods, as distinct
from foodstuffs, products, or nutrients. This creates a curiously reductive,
fragmentary and negative impression. The Declaration certainly should
continue to specify that industrialised dietary patterns are typically too
high in trans-fats, sugars and salt – and also (see below) that they are too
energy-dense, too heavily processed, and too high in alcohol and saturated
fats. *But initial and equal emphasis needs to be given in the Declaration
to the need for well-resourced programmes, involving partnerships between
all relevant government departments as well as other actors, that promote
the protection, production, distribution, marketing, sale and consumption of
healthy fresh and minimally processed foods *

*8    Saturated fats in industrial food supplies need to be sharply reduced*
For the past 30 and more years, official and other authoritative expert
reports, including those issued by WHO, have emphasised the need for food
supplies and thus diets in industrialised countries to contain sharply
reduced amounts of saturated fats. Supporting evidence for cardiovascular
diseases is generally accepted as beyond serious doubt. There is now some
debate in the scientific literature on this point. Perhaps for this reason,
the draft Declaration omits reference to saturated fats in its suggested
'best buys' (an unfortunate term). However, it is essential to specify the
need to reduce production and consumption of saturated fats. The way to do
this, which acknowledges current debate, is to specify the need to reduce
saturated fats, and in particular those that are generated in the production
of processed foods by hydrogenation (see below) which also generates
trans-fats. *In all relevant items, the Declaration needs to specify the
need to reduce the energy-density of manufactured products, and to restrict
and reduce the amount of saturated fats, as well as trans-fats, sugars and
salt, most of all in the manufacture of processed food and drink products. *

*9    Pathogenic types of processing need to be identified and restricted*
Almost all food is processed in some sense, and all the more so if crop and
animal breeding is counted as a type of processing. Many forms of food
processing are directly or indirectly benign in their effects. Some however
degrade food, and some are definitely pathogenic. The very common food
process known to be most malign in its effects is hydrogenation. This
converts relatively unsaturated oils into hard saturated fats, and also
creates trans-fatty acids. The most rational and effective way to reduce the
amount of saturated fats and trans-fats in food supplies is to restrict and
where appropriate prohibit the use of hydrogenation as a food process. *The
Declaration should specify in all relevant items that statutory as well as
voluntary measures are required sharply to restrict and preferably eliminate
the use of hydrogenation, and also all other forms of processing that singly
or in combination generate pathogenic 'ultra-processed' products. *

*10    All forms of malnutrition need to be addressed*
Inasmuch as non-communicable diseases are caused by unhealthy diets, they
are forms of malnutrition. Conventionally, the term is used to refer to
undernutrition, including deficiencies of dietary energy and of
micronutrients, showing as specific diseases, or hunger and starvation. It
is however artificial to separate these from the non-communicable diseases
so far addressed in the Declaration. Malnutrition showing as obesity,
diabetes and other NCDs is increasingly common among impoverished
populations, even in communities and families that are short of food. It is
also crucial that governments in lower-income countries where infectious and
deficiency diseases remain major and urgent public health priorities, see
the need now to give priority to the additional burdens of obesity,
diabetes, cardiovascular and respiratory diseases, and cancer. *The phrasing
of the Declaration needs revision of all relevant items to address this
crucial point. ***

*FOR A FULL VERSION THAT GIVES INSTRUCTIONS ON HOW YOU CAN PARTICIPATE IN
THE PROCESS OF AMENDING THE SUMMIT’S POLITICAL DECLARATION, GO TO:*

http://www.wphna.org/2011_aug_hp3_un_summit.htm



In this URL, you will also find the original text for the Summit proposed by
the UN plus the bracketed version as of changes proposed by nation states as
of July 15.



 A MUST LINK TO LOOK AT IF YOU ARE INTERESTED IN NCDs!
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