Stratagems vs strategy

Governments, industries gang up against WHO's plan

Published: Saturday 15 May 2004

Stratagems vs strategy

-- Struggling with non-communicable diseases, the WHO and Food and Agriculture Organisation (FAO) set up a study group in January 2002 to discuss the problem with health and agriculture experts. The result was TRS 916, a technical report. It says that calories from sugar should form 10 per cent of the daily diet; and high intake of energy-rich and micronutrient-poor foods, sugar-sweetened drinks and fruit juices, large portion sizes of food in restaurants and extensive marketing of such foods are some of the causes for obesity.

With TRS 916 in hand, the WHO team started meeting other UN organisations, non-governmental organisations, consumer groups and industries in order to have a global strategy to prevent obesity. The strategy came out in November 2003, and said changing agriculture, fiscal and regulatory policies, strengthening surveillance systems and consumer education can prevent NCDs. Growing more fruits and vegetables, subsiding healthy food and educating people about food were some of the options countries can use to fight obesity, the strategy said.

These suggestions irked several countries and the food and sugar industries. They realised that what they had presumed would be a harmless health policy went much further and hurt their interests. WHO had in 1990 suggested a similar plan, which recommended the kinds of food people should eat. That plan was never implemented, but the new strategy was again raising debates on agriculture policy, subsidies, consumer education, nutrition and marketing. (see chart: Step by step... to healthy world?)

The 192 member countries of WHO were first given time till January 2004 to comment on the strategy and then the deadline was extended till February 2004 because governments wanted more time to study the suggestions. A total of 68 countries including India have now sent their comments on the strategy, which will become a policy if it's endorsed at the World Health Assembly (WHA) (see box: A taste of who's dish).

The strategy's draft, which will be presented at the WHA, was issued on April 19, 2004, but consumer groups allege that it has been diluted. They say a passage urging states to offer incentives for producing, marketing and transporting fruit, vegetables and other healthy food has been deleted and other changes have been made, weakening the policy.

Sugar barons find it bitter

This strategy isn't going to become an international treaty, but big businesses however fear that if they don't act soon the strategy will become a success like the Framework Convention on Tobacco Control. WHO has repeatedly said that food is not tobacco and it wants to cooperate with the industries. But the industries don't want any restriction on intake of sugar and high-energy food.

The US sugar industry is one of the most pampered and powerful in the world. Domestic sugar price in the US has remained three times that of world prices in the last decade. USA's Sugar Act of 1934 restricts imports and ensures that the government stores excess domestic production. Americans pay US $2 billion annually in inflated sugar prices because of this policy. Using its massive profits, the sugar lobby since 1990 has donated more than US $18 million to Democrats and Republicans. It has given US $490,000 -- a trifle compared the profits -- to the congressional and presidential candidates for the 2003-2004 elections. This lobbying has always worked. During the January 2004 trade talks with Australia, the US refused to open up its sugar market. In December 2003 the US agreed to import one per cent of the sugar it needs from five Central American countries, but its sugar industry has teamed up with the wheat and maize industry to oppose the agreement.

Like in the US, the common agricultural policy of the European Union (EU) protects the sugar market in the continent. Not just the US and EU, even Mauritius, which exports its entire sugar production to EU due to preferential trade arrangements, feels threatened by WHO's strategy. With the EU's sugar policy ending in June 2006 and the US Farm Bill ending in 2007, this is hardly the time for WHO to say that the world should consume less sugar.

Food business takes it personally
Sharing the same boat with sugar is the fast food industry. Since 2000, several studies have warned the fast food business to get rid of its obese image. A study done by Morgan Stanley, an investment consultant group, in 2003 shows that four out of five consumers in UK, USA and France in are trying to give up candies, snacks, fast foods, carbonated and non-carbonated soft drinks and ice cream because they consider them to be unhealthy. Morgan Stanley has also told the industry that presently court cases against it will find it difficult to pinpoint what causes obesity, but that could change if WHO's strategy is approved.

This industry's plan has been to pressure for new laws which make choosing what food to eat a personal responsibility (see box: US says you're what you eat). Two Acts designed to protect the food industry have recently been passed by the House of Representatives. Lobbyists like Dan Spiegel, a former US ambassador to Switzerland and supporter of the Grocery Manufacturers of America, are currently coordinating efforts by the food industry to delay the strategy. "The US food industry is fighting rather than cooperating with efforts to deal with obesity, much as the tobacco industry did for years. This is a self-destructive strategy because public opinion may turn against the industry," says Kelly D Brownell, director, Yale Center for Eating and Weight Disorders, USA.

Countries put up a divided house
Helping these two industries is the confusion and division among WHO's member countries over the strategy. At the WHO executive board meeting of member countries on January 21, 2004, a debate on the strategy proved inconclusive. Of the 34 nations who commented on the strategy, only UK, Canada, New Zealand, Spain and South Africa accepted it. India asked for more time to study the strategy. Pakistan asked for more scientific evidence. USA wanted more focus on personal responsibility, and India and 12 other countries said they "agree with the US".

Several developing countries like Mauritius, Philippines, and India have written letters to the WHO and told it that they believe that the strategy exclusively focuses on overeating and it should also consider "under-eating". Bosnia and Herzegovina supports the idea that if people are given good food it will take care of under-nutrition, Belgium believes that personal responsibility concept cannot be applied to children and the Czech Republic doesn't agree that people would make healthier choices if 'bad food' is made expensive.

Sugar-growing countries like Mauritius, Barbados and Cuba opposed limiting consumption though their health guidelines restrict calorie intake. Mauritius advises its citizens to have less than 50 gm of sugar per day (less than 10 per cent of the diet), but it won't support WHO's global strategy on restricting calories.

Nations fight, industry gains
The London-based International Sugar Organisation sent a memo to members (sugar companies from around the world) on February 17, 2004 informing them with glee that FAO has not accepted TRS 916.

The basis for this statement was a FAO meeting in Rome on February 9-10, 2004 during which G77 countries and the China Group had raised concerns on whether TRS 916 will affect agriculture. The International Sugar Organisation, however, told its members that using this concern among G77 nations, they could ensure that the strategy isn't adopted at the WHA. Experts say that with consumer groups putting pressure on their government, the US is finding it difficult to stall the strategy and therefore has put the developing countries on the forefront to fight its battle.

"They (sugar industry) have questioned the scientific basis of the expert findings and generated fear that sugar production could be affected if the WHO's recommendations are observed. This is evidently undermining the confidence of some developing countries as evidenced by the G77 response at the FAO meeting in Rome," says Neville Rigby, director, policy and public affairs, International Obesity Task Force, London.

"Lobbying groups are exerting pressure on governments to support corporate interests over public health. The WHO report has nothing new in its dietary recommendations, particularly the one suggesting no more than 10 per cent of calories from added sugars. The reason why the report is causing trouble is that it actually recommends methods for achieving this doing something about it," says Marion Nestle, professor of public health, New York University.

"The main thing is to have the strategy approved. It shouldn't be blocked by commercial lobbying, especially from the sugar industry," says Pekka Puska, director general of National Public Health of Finland and former member of the team which drafted the strategy. Right now it's unclear what stand countries would take at the WHA. Among G77 countries, Brazil and Pakistan haven't decided; India doesn't accept all aspects of the strategy (see box: India's strategy: keep waiting) and Mauritius wants to avoid it. At Geneva, officials at WHO's headquarters feel that they have done their best and all that they can do now is wait and watch. "We have taken into account all of the additional comments we received by the deadline, and made relevant changes in the strategy. It will now be up to our member states at the WHA to consider endorsing the strategy," says Amalia Waxman, project manager for the global strategy.

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