Paula Johns is an NCD Alliance Board Member and former tobacco control advocate who is now dedicated to promoting policies to improve the quality of diets in Brazil, Latin America and globally. She spoke about accelerating progress in the Sustainable Development Goals through the implementation of the Global Action Programme (GAP) on Food Security and Nutrition in small island developing states at the UN High-Level Political Forum on 15 July. This blog reflects her remarks.

Confronting the Global Syndemic

NCDs are the leading causes of death worldwide and account for nearly two-thirds of all global deaths. Low- and middle-income countries (LMICs) and the poorest and most vulnerable populations are the hardest hit, including the small island developing states – but the global NCD epidemic can be significantly reduced if we take action now to address its drivers such as tobacco use, harmful use of alcohol, poor diet, physical inactivity, and air pollution.

In January 2019, The Lancet Commission on Obesity published a report that was very relevant to the context of small islands, entitled ‘The Global Syndemic of Obesity, Undernutrition and Climate Change’1. Malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally. Climate change can also be considered a pandemic because of its sweeping effects on the health of humans and the natural systems we depend on (i.e., planetary health). 

These three pandemics—obesity, undernutrition, and climate change—represent the Global Syndemic. They constitute a synergy of epidemics, because they co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers.

The key broad policy recommendations of the Global Syndemic report are:

1) Think in Global Syndemic terms to create a focus on common systemic driversthat need common actions.

2) Join up the silos of thinking and action to create platforms to work collaboratively on common systemic drivers and double-duty or triple-duty actions.

3) Strengthen national and international governance levers to fully implement policy actions that have been agreed upon through international guidelines, resolutions and treaties. But beware of conflicts of interest when developing them!

4) Strengthen municipal governance levers to mobilise action at the local level and create pressure for action at the national level.

5) Strengthen civil society engagement to encourage systemic change and pressure for policy action at all levels of government to address the Global Syndemic.

6) Reduce the influence of large commercial interestsin the public policy development process to enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet.

7) Strengthen accountability systems for policy actions to address the Global Syndemic.

8) Create sustainable and health-promoting business models for the 21st century to shift business outcomes from a short-term profit-only focusto sustainable, profitable models that explicitly include benefits to society and the environment. Business as usual is clearly not working!

9) Focus research on the Global Syndemic determinants and actionsto create an evidence base of systemic drivers and actions, including indigenous and traditional approaches to health and wellbeing.

The challenge of changing food systems 

The common drivers of obesity, undernutrition, and climate change indicate that many systems-level interventions could serve as double-duty or triple-duty actions to change the trajectory of all three pandemics simultaneously. However, a simple example shows how challenging these actions can be to achieve. 

National dietary guidelines serve as a basis for the development of food and nutrition policies and public education to reduce obesity and undernutrition, and could be extended to include sustainability by moving populations towards consuming largely plant-based diets.However, many countries' efforts to include environmental sustainability principles within their dietary guidelines failed, due to pressure from strong food industry lobbies — especially the beef, dairy, sugar, and ultra-processed food and beverage industry sectors. Only a few countries (Brazil being one of them) have developed dietary guidelines that promote environmentally sustainable diets and eating patterns that ensure food security; respond to climate change challenges; and improve diet quality, human health and wellbeing, and social equity.

It is not easy to achieve the systemic changes needed to redirect food systems and stop the current dietary transition from real foods into more ultra-processed foods, as personal behaviours are heavily influenced by environments that are obesogenic. However, there are simple and cost-effective policies that can support the creation of healthier and more sustainable food systems, such as 1) fiscal policies (i.e. taxation of harmful products); 2) marketing restrictions; 3) clear front of package warning labelling (such as the Chilean model) for harmful ultra-processed beverages and foods; and 4) the promotion of healthier institutional food environments, such as schools and others. 

These four key policy areas can help to include part of the cost of externalities in the final cost of the product. Regulation in these areas helped to curb the tobacco epidemic, and we can apply these lessons learnt to food policy issues as well.

The health of the planet and the health of people walk hand in hand

In conclusion, as long as it is cheaper and more profitable to produce and sell ultra-processed products rather than to produce real and healthy foods that do not pollute the air, water and soil, or harm the health of farmers and consumers, it will be impossible to achieve real and lasting food and nutrition security.

Therefore, I urge Member States, the UN System, and all of us in the broader food and nutrition community to embrace an integrated food system and public policies approaches that places people and the planet at the center. 

About the author

Paula Johns (@johnspaula) is the general director and co-founder of ACT Health Promotion @actbr, an NGO that leads a Brazilian coalition of more than 1000 members created to support policies aimed at decreasing the burden of NCDs. She is also an NCD Alliance Board Member. 

Notes

1 - In January 2019, The Lancet Commission on Obesity published a report that was very relevant to the context of small islands, entitled ‘The Global Syndemic of Obesity, Undernutrition and Climate Change’. NCDA's member World Obesity Federation was a core partner in the Commission and is now leading the translation to policy and action.