Study highlights 'systematic opposition' to regulation in tackling NCDs from food industry

A new study out this week during the Global Week for Action on non-communicable diseases (NCDs) highlights that global public health regulation intended to tackle unhealthy diets, a key risk factor for NCDs, is being consistently opposed by the food and drinks lobby.

NCDs, such as heart disease, cancer, and diabetes, account for over 70% for global death and disability but failure to implement co-ordinated and targeted action has led to a growing problem - evidenced through the current obesity crisis facing much of the world.

The new research, from health policy analysts at Bath in collaboration with researchers from the universities of Edinburgh and São Paulo, and the World Public Health Nutrition Association, examined all food industry responses to consultations held by the World Health Organization (WHO) on NCD policy and governance between September 2015 and September 2018.

By evaluating responses across five separate consultations run by the WHO throughout this period, the work shows that, despite a rhetoric of support for public health, food industry groups consistently oppose effective regulations such as taxes and marketing restrictions, and advocate for weaker voluntary and partnership approaches instead.

Lobby groups also challenged established public health evidence about tackling NCDs. For example, the International Council of Beverages Associations which represents the soft drinks industry questioned the well-established link between sugar-sweetened beverages and obesity suggesting:

'The overall weight of the scientific evidence on sugar and/or sugar-sweetened beverages show that they do not have a unique effect on body weight beyond their contribution to total calorie intake.'

In addition, the lobby group inaccurately argued that the world's leading public health agency was not in a position to advise on health taxes:

'Offering such policy advice in a field - economics and fiscal policy - far from WHO's expertise is not in our opinion a prudent course of action.'

In fact, argue the researchers, the WHO includes among its staff many economists and the World Bank also promotes the use of health taxes.

The researchers suggest that the arguments used are similar to those deployed by the tobacco industry when the WHO started to take stronger action to regulate cigarettes in the early 2000s. These included claiming that regulation would not work or was not needed, and questioning the science and evidence underlying policies such as sugar-sweetened beverage taxation.

Recognising that good health is essential to development, the UN's landmark Sustainable Development Goals (SDGs) include a target to promote health and reduce premature mortality from NCDs by one third by 2030 (SDG 3). The COVID-19 pandemic, which affects people living with NCDs more severely, has shown how important this is.

Yet, the researchers highlight a possible tension between this goal, to improve health, and another, SDG 17, which promotes public-private partnerships. They document how food industry groups use the latter to promote industry involvement in policymaking, which for many is seen to be undermining attempts to improve health. A number of groups used SDG 17 to oppose a tool developed by the WHO to help member states protect nutrition programmes against conflicts of interest, arguing that such limitations on engagement with the food industry would not be coherent with the partnership aim promoted by the goal.

Lead author, Kathrin Lauber from the Tobacco Control Research Group at the University of Bath explains: "What happens at the WHO, and what doesn't happen, is important to all of us. The agency's guidelines can provide countries with a mandate to introduce crucial public health protections, which is why we see food and drink lobby groups pushing to keep the policy recommendations weak. Moreover, positioning collaboration with the commercial sector as a default risks impeding not only the work of the WHO as the UN's key health agency, but also that of countries across the world working to reduce the burden of NCDs."

Lucy Westerman, Policy and Campaigns Manager, NCD Alliance said: "As one of the many civil society advocates who engaged tirelessly in these same nutrition and noncommunicable disease (NCD) related WHO consultations and processes between 2015-2018, and who witnessed engagement of industry in some of these processes and related negotiations and outcomes, this analysis is extremely welcome and enlightening. The researchers' analysis illuminates but one of many ways in which such unhealthy commodity industries seek to dilute global health policy undermining efforts to ensure all people have access to healthy, nutritious diets. If we are to realise nutrition, NCD and Sustainable Development Goal targets and health for all, these industries cannot be allowed to dilute public health policy."

This study was funded by the Roger and Sue Whorrod PhD Studentship. Professor Anna Gilmore and Kathrin Lauber are members of SPECTRUM, a UK Prevention Research Partnership (UKPRP) Consortium.

'Non-communicable disease governance in the era of the sustainable development goals: a qualitative analysis of food industry framing in WHO consultations' is published in the journal Globalization and Health https:/​/​globalizationandhealth.​biomedcentral.​com/​articles/​10.​1186/​s12992-020-00611-1.