[Source: the Lancet]

The global interplay of obesity, undernutrition and climate change represents 'The Global Syndemic' and is the greatest threat to human and planetary health, affecting most people in every country and region.
Powerful opposition by commercial vested interests, lack of political leadership, and insufficient societal demand for change are preventing action on The Global Syndemic, with rising rates of obesity and greenhouse gas emissions, and stagnating rates of undernutrition.
New social movement for change and radical rethink of the relationship between policymakers, business, governance and civil society is urgently needed.
The Commission calls for a global treaty to limit the political influence of Big Food (a proposed Framework Convention on Food Systems – modelled on global conventions on tobacco and climate change), redirection of US $5 trillion in government subsidies away from harmful products, and advocacy from civil society to break decades of policy inertia.

Leaders must take a hard line against powerful commercial interests and rethink global economic incentives within the food system in order to tackle the joint pandemics of obesity, undernutrition and climate change, according to a major new report by the Lancet Commission on Obesity, co-authored by SFI External Professor Ross Hammond, a Senior Fellow in Economic Studies at the Brookings Institution. A key recommendation from the Commission is the call to establish a new global treaty on food systems to limit the political influence of Big Food.

Malnutrition in all its forms, including undernutrition and obesity, is by far the biggest cause of ill-health and premature death globally. Excess body weight affects 2 billion people worldwide, 2 billion people suffer from micronutrient deficiency, and both are expected to be made significantly worse by climate change [1].

Over the past two decades, obesity, undernutrition and climate change have been viewed as separate, and policy responses have been unacceptably slow due to reluctance of policy makers to implement effective policies, powerful opposition by vested commercial interests, and insufficient demand for change by the public and civil society. Undernutrition is declining too slowly to meet global targets, no country has reversed its obesity epidemic, and comprehensive policy responses to the threat of climate change have barely begun.

Led by the University of Auckland (New Zealand), the George Washington University (USA), and World Obesity Federation (UK), the new Lancet Commission is the result of a three-year project led by 26 experts from 14 countries. The report follows the publication on 17 Jan of the Lancet-EAT Commission, which provided the first scientific targets for a healthy diet within planetary boundaries [2].

"Taking a complex systems perspective caused this commission to realize that there are in fact three different pandemics going on —obesity, under nutrition, and climate change — that actually have common drivers and in some cases directly connected causes," Hammond says. "That opens the door to the potential for connected or common solutions to the problem. That's a deeply rooted in an understanding of the underlying systems, how they connect, and the many different causes of these problems they lead to."

The new Commission defines The Global Syndemic as the global interactions of the pandemics of obesity, undernutrition and climate change, which are linked through common drivers and shared solutions. Driving The Global Syndemic are food and agriculture policies, transportation, urban design and land use systems — which in turn are driven by policies and economic incentives that promote overconsumption and inequalities.

Among the actions recommended, the Commission calls for the establishment of a Framework Convention on Food Systems (FCFS) — similar to global conventions for tobacco control and climate change – to restrict the influence of the food industry in policy making and to mobilise national action for healthy, equitable and sustainable food systems.

Economic incentives must be redesigned, and US $5 trillion in government subsidies to fossil fuel and large agricultural businesses globally should be redirected towards sustainable, healthy, environmentally friendly activities. Additionally, a global philanthropic fund of US $1 billion must be set up to support civil society in advocating for change.

“Until now, undernutrition and obesity have been seen as polar opposites of either too few or too many calories. In reality, they are both driven by the same unhealthy, inequitable food systems, underpinned by the same political economy that is single-focused on economic growth, and ignores the negative health and equity outcomes. Climate change has the same story of profits and power ignoring the environmental damage caused by current food systems, transportation, urban design and land use. Joining the three pandemics together as The Global Syndemic allows us to consider common drivers and shared solutions, with the aim of breaking decades of policy inertia,” says Commission co-chair Boyd Swinburn of the University of Auckland. [3]

“The prevailing business model of large international food and beverage companies that focus on maximising short-term profits leads to overconsumption of nutrient-poor food and beverages in both high-income countries and increasingly in low and middle-income countries. The coexistence of obesity and stunting in the same children in some countries is an urgent warning signal – and both will be exacerbated by climate change. Tackling The Global Syndemic requires an urgent rethink of how we eat, live, consume, and move, including a radical change to a sustainable and health-promoting business model fit for the future challenges we face today,” says Richard Horton, Editor-in-Chief, The Lancet. [3]

The Global Syndemic: common drivers require double or triple-duty actions

The Global Syndemic represents a synergy of pandemics that co-occur in time and place, interact with each other, and share common underlying societal drivers. For example, food systems not only drive the obesity and undernutrition pandemics but also generate 25-30% of greenhouse gas emissions (GHGs), and cattle production accounts for over half of those. Car-dominated transportation systems support sedentary lifestyles and generate between 14-25% of GHGs. Underpinning all of these are weak political governance systems, the unchallenged economic pursuit of GDP growth, and the powerful commercial engineering of overconsumption.

The outcomes of obesity, undernutrition, and climate change also interact. For example, climate change will increase undernutrition through increased food insecurity from extreme weather events, droughts, and shifts in agriculture. Likewise, fetal and infant undernutrition increases the risk of adult obesity. Climate change may also affect prices of basic food commodities, especially fruit and vegetables, potentially increasing consumption of processed foods.

Double-duty or triple-duty actions influence multiple parts of the syndemic simultaneously, aiming to re-orient the major drivers of The Global Syndemic at local, national and global levels. Guidelines for a sustainable diet, the restriction of commercial influences, the right to wellbeing legislation, and policies for healthy, equitable, environmentally sustainable, economically prosperous food systems would all present double or triple duty actions.

Additional examples of triple duty actions include:

Reducing red meat consumption through taxes, redirected subsidies, health and environmental labelling, and social marketing would lead to healthier diets for cancer and obesity prevention, more land for efficient, sustainable agriculture, providing opportunities to reduce undernutrition, and lower GHG emissions from agriculture.
Supporting active transportation through infrastructure, taxes and subsidy shifts, and social marketing strategies would lead to increased physical activity and less sedentary time, with an impact on obesity prevention, cheaper transport access to healthy food and employment, potentially reducing poverty and undernutrition, and lower GHG emissions from transportation.

Commercial vested interests: a powerful driver of The Global Syndemic

Economic power has been increasingly concentrated into fewer, larger companies. Key strategies used by the food industry to obstruct obesity prevention policies have included adopting self-regulation to pre-empt or delay state regulation, public relations efforts portraying industry as socially responsible while undermining and contesting the strength of scientific evidence, direct lobbying of government decision-makers, and framing nutrition as a matter of individual responsibility.

“With market power comes political power, and even willing governments struggle to get policies implemented against industry pressure. New governance dynamics are needed to break the policy inertia preventing action. Governments need to regain the power to act in the interests of people and the planet and global treaties help to achieve this. Vested commercial interests need to be excluded from the policy table, and civil society needs to have a stronger voice in policy-making. Without disruptive change like these, we will continue on with the status quo which is driving The Global Syndemic,” says Commissioner Tim Lobstein, World Obesity Federation, London (UK) [3].

Attempts to include sustainability in national dietary guidelines in the USA and Australia failed as a result of food industry pressure to remove sustainability from the terms of reference. In the USA, subsidies for fossil fuels keep petrol prices artificially low, encouraging car use and disincentivising investment in active and public transportation. In 2016-17, the sugary drinks sector spent US$50 million to lobby against local initiatives to reduce soda consumption, and research funded by the sector is five times less likely to find an association between sugary drinks and obesity compared to other studies.

The food industry’s obstructive power is further enhanced by governance arrangements that legitimise industry participation in public policy development, and the power that big corporations have to punish or reward governments by relocating investment and jobs. Furthermore, outlawed marketing practices in one country have been introduced or sustained in non-regulated countries. In Nepal, Ghana, South Africa, and Mongolia marketing for sugary drinks is common around schools, and school entrances in ways that would not be acceptable in high-income countries.

Regulatory approaches to product reformulation (eg. salt and sugar reduction), labelling and marketing to children are needed because industry-led, voluntary approaches have not been effective. Quasi-regulatory approaches that are government-led but still voluntary (such as Public Health England’s sugar reformulation programme) may prove more successful, but clear methods of accountability and sanctions for failures to meet targets are needed.

A Framework Convention on Food Systems modelled on tobacco and climate change treaties

The WHO Framework Convention on Tobacco Control (FCTC) and the United Nations Framework Convention on Climate Change (UNFCC) provide valuable models for a global approach to tackle the negative health and environmental effects of the food system.

The Commission calls for a new Framework Convention on Food Systems (FCFS) to link the powerful players around food systems into a common agreement, enabling governments to add elements of public health, social equity and environmental protection.

Based on Article 5.3 of the FCTC, a new FCFS would explicitly exclude the food industry from policy development. Such a commitment would recognise the fundamental and irreconcilable conflict that exists between some food and drinks industries’ interests and those of public health and the environment; that all parties must be transparent and accountable when dealing with industry or working to further their interests; and that no fiscal advantages or inducements to produce food and beverage products that damage human and environmental health should exist.

“Although food clearly differs from tobacco because it is a necessity to support human life, unhealthy food and beverages are not. The similarities with Big Tobacco lie in the damage they induce and the behaviours of the corporations that profit from them. A Framework Convention on Food Systems would help empower individual nations against vested commercial interests, redirect the vast subsidies that currently benefit unhealthy industries, and provide full transparency,” says author Professor William H. Dietz, George Washington University, Washington DC (USA). [3]

Subsidies that foster ill health must be redirected

In 2015, global subsidies from governments to the fossil fuel industries were about US $5.3 trillion per year, and nearly half a trillion US dollars went to agricultural subsidies (mostly for beef and dairy, as well as grains used in animal feed or ultra-processed foods) in the top 21 food-producing countries every year.

As industries continue to increase their profits, the costs of the environmental and health damage linked to their products are overwhelmingly borne by current and future generations of tax payers. The Commission argues that these subsidies should be redirected to incentivise healthy and environmentally sustainable agriculture. Furthermore, the costs of products such as red meat and petrol should reflect the costs of their damages to the environment.

New business models fit for the challenges of the 21st century are needed to incentivise sustainable businesses in support of the public good, and broaden the business focus to explicitly include benefits to health, society and the environment.

Civil society: a much-needed disruptive force

Effective strategies to address the Global Syndemic will be unlikely to succeed without a broader base of support. The recent withdrawal of the USA from the Paris Climate Change Agreement demonstrates the fragility of agreements that might change based on the politics of the countries involved. Yet, despite the administration’s decision, 2700 leaders from US cities, states, and businesses representing 159 million people and US $6.2 trillion in GDP have continued efforts to mitigate greenhouse gas emissions.

Mobilisation of civil society was crucial in driving commitment for a sugary drinks tax in Mexico. Despite strong resistance from the beverage industry aimed at watering down the proposed measures, a 10% tax was added to sugary drinks. Within two years, consumption of sugary drinks was reduced by 7.6%.

The Commission calls for US $1 billion from philanthropic and other sources to support 100 countries to apply Mexico’s approach to implement food and nutrition policies.

“The past few years have seen renewed activism at the local level, whether in cities, communities, or in particular issues. As with other social movements, such as campaigns to introduce sugary drink taxes, efforts to address the Global Syndemic are more likely to begin at the community, city, or state level, and subsequently build to a national or global level. Support for civil society is crucial to break the policy deadlock and the systems driving the Global Syndemic,” adds Dietz. [3]

Read the commission in The Lancet (January 27, 2019)

Read the policy brief

[1] Key data on obesity, undernutrition and climate change:

Excess body weight is estimated to affect 2 billion people worldwide, causing 4 million deaths, at a cost of $US2 billion annually, or 2.8% of the world’s GDP.
At the same time, stunting and wasting affect 155 million and 52 million children worldwide, 2 billion people suffer from a micronutrient deficiency, and 815 million people are chronically undernourished. In Africa and Asia, undernutrition costs 4-11% of GDP.
Estimates of the future economic costs of climate change are 5-10% of the world’s GDP, with costs in low-income countries that may exceed 10% of their GDP.
Food production is one of the largest contributors to climate change. Agriculture contributes 15-23% of all greenhouse gas emissions, comparable to transportation. When land conversion, food processing, and waste are taken into account, it can be as high as 29%.

[2] Lancet-EAT Commission www.thelancet.com/commissions/EAT

[3] Quotes direct from authors and cannot be found in the text of the Commission.

[Source: the Lancet]

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