Search results: public health strategies

I thought the FDA had decided long ago that dietary supplements were untouchable, given the Courts’ interpretation of the Dietary Supplement Health and Education Act (DSHEA) of 1994.  DSHEA essentially deregulated dietary supplements and blocked the FDA from doing much about them unless it could prove substantial harm.

Whenever the FDA tried to intervene, supplement companies took the agency to court on First Amendment grounds, and won most of the time.  So the FDA appeared to have given up.

But here we have FDA Commissioner Scott Gottlieb announcing new steps to take back some oversight of this industry.

These steps include communicating to the public as soon as possible when there is a concern about a dietary supplement on the market, ensuring that our regulatory framework is flexible enough to adequately evaluate product safety while also promoting innovation, continuing to work closely with our industry partners, developing new enforcement strategies and continuing to engage in a public dialogue to get valuable feedback from dietary supplement stakeholders.

The FDA issued a press release to announce 12 warning letters and 5 online advisory letters to companies illegally selling more than 58 misbranded products claimed to prevent or treat Alzheimer’s disease.  The demographic change to an aging population:

has been accompanied by a growth in the number of marketers who prey on this population, pitching products that make unproven claims that they can prevent, treat, delay, or even cure Alzheimer’s disease.  These purported miracle cures are sold primarily on the Internet. They are often, though not always, falsely labeled as dietary supplements. Regardless of their form, these products fly in the face of true science. What these companies are selling is the false hope that there is an effective treatment or cure.

Commissioner Gottlieb also sent out a chain of Twitter announcements explaining what this is about.

Cheers to the FDA for this one.  And now get busy on the rest of the bad apples in this barrel.

I signed a letter published in Le Monde on September 18:  La “lutte contre les maladies non transmissibles:” une urgence sanitaire mondial.  It is addressed to the The Third United Nations High-Level Meeting on Noncommunicable Diseases taking place in New York today.  Here it is in English translation.

The Fight Against Non-Communicable Diseases: A Global Emergency

Just 10 years ago, infectious diseases such as tuberculosis, HIV/AIDS and malaria were the main worldwide threat for health. But today, Non-Communicable Diseases (NCDs), such as diabetes or cardiovascular disease, which only receive 2% of the total financing allocated by international health partners, constitute a health emergency in high-income countries and low-income countries alike.

Changes in food consumption and increasingly sedentary lifestyles have a strong impact on human health and the environment, and increase risks of developing NCDs. For over 10 years now, Non-Communicable Diseases have become the main causes of death in the world, leading to 15 million premature deaths every year.

Today, these changes in lifestyles are hitting hard low-income and intermediate countries. Contrary to common belief, a large number of inhabitants in West Africa are faced with overweight and obesity. Who could imagine that 38% of women of childbearing age there are already overweight and 15% are obese? The increase in the consumption of animal fats and industrial foodstuffs, combined with massive urbanization source of lifestyle change more conducive to NCDs,  are the causes of these epidemiological transitions.

The agri-food industry, the driver of these changes, has an impact on both human health and the environment. The intensification of production methods, the overconsumption of meat, the massive use of chemical products in agriculture (glyphosate), and the use of chemical substances and packaging (phthalates) to preserve food have a major impact on the environment and contribute to the high level of CO2 emissions. At the same time, too much fat, too much sugar, food with too many calories and a major consumption of sweetened beverages and alcohol, or food contaminated by pesticides, combined with a reduction in physical activity, are major risk factors for NCDs.

Diabetes is a perfect illustration of this strong link between the health of populations and the health of our planet and the related challenges. In 2017, 425 million people were living with diabetes. One person died from it every 6 seconds and the disease cost USD 723 bn. Diabetes is also the leading cause of blindness, persons undergoing dialysis and non-traumatic amputations around the world. The International Diabetes Federation estimates that by 2045, there will be 628 million patients, over 80% of which will be living in low-income and middle-income countries. Diabetes will affect 42 million people in Africa and will cost the African continent USD 6.6 bn. 90% of cases of diabetes would be avoidable if we adopted ambitious prevention policies aiming at changing eating behavior and sedentary lifestyles.

Unfortunately, this objective is still a dream. For people who are already suffering from diabetes, treatments are extremely expensive for the patient, their family, but also for governments. In certain countries, these treatments are not available to all, and in others, these treatments are available, but the cost is a huge burden. In Africa, an antidiabetic drug like insulin is only available in 40% of countries and at a very high price. For example, in Mali, 56% of households with a diabetic patient devote over 40% of their incomes to healthcare payments. Policies for access to treatments are consequently essential.

• Feed the planet more healthily in order to reduce the impact of poor nutrition on human health and the environment;
• Prevent chronic diseases in order to reduce their economic burden;
• Provide patients suffering from an NCD with access to treatments essential for their care at an affordable cost or “free” thanks to universal health coverage;
• Regulate private sector involvement in order to reduce conflicts of interests and achieve real progress in the quality of food products and access to treatments.

These challenges require taking urgent measures:

—Adopt a taxation and regulations that guarantee healthy and ecological nutrition

• Adopt taxes on alcohol and sweet beverages to reduce their consumption (based on the sugar tax model in France);
• Universalize labelling on food content (like Nutri-Score);
• Ban adverts on junk food targeting the youngest public;
• Adopt positive tax measures to make healthy products with high nutritional qualities cheaper.

—Develop prevention programs which will allow consumers to make better food choices, while ensuring there are living and working spaces favorable for doing a regular physical activity.

—Ensure access to high-quality treatments at a lower cost for NCDs and include the medical treatments/systems required for universal health coverage.

—Finance the global response against NCDs by a Trust Fund to structure effective prevention in countries which do not have sufficient means, and exchange expertise to support countries in their strategies to fight against NCDs.

Signatories

• Cynthia Fleury – Philosophe et Professeur au Conservatoire National des Arts et Métiers)
• Stéphane Besançon – Directeur Général de l’ONG ONG Santé Diabète
• Gaël Giraud – Chief Economist Agence Française de Développement
• Cyril Dion – Réalisateur et cofondateur du mouvement Colibris
• Katie Dain – Directrice Générale de l’ONG NCD Alliance
• Pierre Salignon – Responsable des partenariats avec la société civile à l’Agence Française de Développement
• Marion Nestle – Professeur de Nutrition à l’Université de New York et écrivaine
• David Beran – Chercheur, service de médecine tropicale et humanitaire des Hôpitaux universitaires de Genève
• Jean Marie Milleliri – Secrétaire Général du Groupe d’intervention en santé publique et épidémiologie
• David Hacquin – Président de l’ONG Santé Diabète

Camille Mary – Coordinatrice ONG Santé Diabète

—Copyright ID4D

Access to Nutrition has just published its 2018 global report.  Its Global Index:

Measures companies’ contributions to good nutrition against international norms and standards and includes a separate ranking of the world´s leading manufacturers of breast-milk substitutes (BMS).

The report summarizes its findings:

The 2018 Index shows the world’s biggest F&B companies have stepped up their efforts to encourage better diets, mostly through new and updated nutrition strategies and policies, improved commitments on affordability and accessibility, better performance on nutrition labeling and health and nutrition claims, and more disclosure of information across categories. Nevertheless, ATNF has serious concerns about the healthiness of the world’s largest global F&B manufacturers’ product portfolios.

Access to Nutrition ranks the European companies, Nestlé, Unilever, and Danone, highest on its lists.

Its “serious concerns”?

• Poorly defined reformulation targets
• Unclear approaches to making healthy products for affordable and accessibe
• Continued irresponsible marketing to children
• Inadequate employee education programs
• Inadequate support to breastfeeding mothers
• Inadequate labeling
• Inadequate support for public health measures

On this last one:

Indeed.

I vote for smokescreen.

Let’s take this one step at a time, starting with the FY 2019 Budget announced last week.  In this administration’s usual Orwell-speak:

The Budget proposes a bold new approach to administering the Supplemental Nutrition Assistance Program (SNAP) that combines traditional SNAP benefits with 100-percent American grown foods provided directly to households and focuses administrative reforms on outcome-based employment strategies. The Budget expands on previous SNAP proposals to strengthen expec­tations for work among able-bodied adults, pre­serves benefits for those most in need….

Translation: work requirements and budget cuts.  These are emphasized in the FY 2019 Budget Addendum.  This proposes a $17 billion cut in funding ($213 billion over the next decade).  In more Orwell-speak, it is

designed to improve nutrition and target benefits to those who need them while ensuring careful stewardship of taxpayers’ money. This  suite of proposals includes a new approach to nutrition assistance that combines retail-based SNAP benefits with a package of nutritious, 100 percent American-grown food. The Budget also encourages States to innovate in helping participants move to self-sufficiency and improving employment outcomes.

This language comes directly from USDA Secretary Sonny Perdue’s Big Idea: America’s Harvest Box, specified as containing:

Shelf-stable milk, juice, grains, ready-eat-cereals, pasta, peanut butter, beans, canned meat, poultry or fish, and canned fruits and vegetables.

The box would account for roughly half the benefits; the other half would come from using EBT cards, as in the past.

What got all the attention was a statement from White House OMB Director Mick Mulvaney, as reported in the Washington Post:

What we do is propose that for folks who are on food stamps, part — not all, part — of their benefits come in the actual sort of, and I don’t want to steal somebody’s copyright, but a Blue Apron-type program where you actually receive the food instead of receive the cash,” Mulvaney said. “It lowers the cost to us because we can buy [at wholesale prices] whereas they have to buy it at retail. It also makes sure they’re getting nutritious food. So we’re pretty excited about that.

Blue Apron, in case you haven’t been keeping up with this, is a meal-delivery service that has had some fiscal problems lately.

The budget plan includes some “add-back” requests for additional funds for special purposes.  One such request is for $30 million to test whether the Harvest Box plan works.

Under this proposal grants would be made to a small number of states to design, implement, and evaluate the provision of a package of USDA Foods in combination with the traditional Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) electronic benefits used at approved retailers. This supports early implementation and evaluation of the related 2019 Budget proposal, which calls for this program structure nationwide and is estimated to save over $12 billion in 2019, and $129 billion over ten years. These grants would provide important policy and administrative lessons to inform efficient and effective nationwide implementation.

What are we to make of all this?  My favorite reaction comes from Politico: “Trump’s Food Stamp Idea Is Like Blue Apron Had a Socialist Hangover.”

It is hardly pro-market to displace the private sector and build a parallel, state-run distribution system, no matter how many times you name-check Blue Apron. This is the sort of thing you find in countries still recovering from socialist hangovers…No, the “Harvest Box” approach to hunger policy makes sense only in the context of hunger politics. And hunger politics have always been as much about the welfare of agribusiness as about the welfare of the poor…. It is generally more expensive than either buying food locally and distributing it or simply giving the recipients cash or vouchers to purchase their own food. Rigorous experimental testing has shown that it does not even produce systematically better nutritional outcomes than giving out money.

I particularly enjoyed Andy Fisher’s comments.  Fisher is author of Big Hunger: The Unholy Alliance between Corporate America and Anti-Hunger Groups (see my Weekend Reading post on this book).  “Comrade Trump, he says, might just be on to something.”  SNAP, he points out,

is an accomplice to our need for cheap food with the accompanying externalities caused to public health. It reinforces the ills of the marketplace rather than seeks to transform them.”

His suggestion?  Nationalize the grocery industry.

The NY Times pointed out that even Trump administration officials don’t think this is a serious proposal:

administration officials on Tuesday admitted that the food-box plan…had virtually no chance of being implemented anytime soon.  Instead, the idea…was a political gambit by fiscal hawks in the administration aimed at outraging liberals and stirring up members of the president’s own party working on the latest version of the farm bill.  The move, they said, was intended to lay down a marker that the administration is serious about pressing for about $85 billion in other cuts to food assistance programs that will be achieved, in part, by imposing strict new work requirements on recipients.

Let’s be clear what this about: Cuts to SNAP.  As the Center for Budget and Policy Priorities analyzes the situation, the plan intends to cut SNAP benefits as well as:

• Expand government bureaucracy
• Shift costs to states and nonprofits
• Increase costs for participants
• Restrict access to fresh fruits and vegetables
• Increase stigma for low-income households
• Negatively impact retailers

Let me add a couple of other points:

• If you want to help the poor and save money, use cash transfers.  These demonstrably work better.
• If you want food boxes to improve nutritional status, go to the WIC model and include some fresh foods.

The bottom line:  pay attention to the budget cuts.

The USDA announces its revised school meal rules, in words that would make George Orwell proud:

The U.S. Department of Agriculture (USDA) today provided local food service professionals the flexibility they need to serve wholesome, nutritious, and tasty meals in schools across the nation. The new School Meal Flexibility Rule…reflects USDA’s commitment, made in a May proclamation to work with program operators, school nutrition professionals, industry, and other stakeholders to develop forward-thinking strategies to ensure school nutrition standards are both healthful and practical…This action reflects a key initiative of USDA’s Regulatory Reform Agenda, developed in response to the President’s Executive Order to alleviate unnecessary regulatory burdens.

Try and get your head around this.  The revised rules make school meals less nutritious.  They allow schools to:

• Serve flavored rather than plain low-fat milk (higher in sugar)
• Be exempt from serving whole grain-rich products.
• Have until the end of the 2020-2021 school year to reduce the salt in school meals.

This rule will be in effect for SY 2018-2019. USDA is accepting public comments for longer term use at www.regulations.gov.

I will never understand why adults would lobby to make school meals less healthful, but here is the School Nutrition Association praising the changes.  The Association cites survey data indicating that 65 percent of school districts are having trouble with whole grains and 92 percent with sodium requirements.

I love Margo Wootan’s quote (she is director of nutrition policy at the Center for Science in the Public Interest):

The proposal is a hammer in search of a nail…Virtually 100 percent of schools are already complying with the final nutrition standards, including the first phase of sodium reduction.

Here are:

• USDA’s press release
• CSPI’s press statement
• American Heart Association’s press release

Sustainable Food Trust has a report on a conference on the True Cost of American Food.

Health is the obvious cost, but others include:

• the cost of nitrate and pesticide pollution of ground and river water from agro-chemicals, which in some areas of the US are so high that the water industry is struggling to provide drinking water within legal limits,
• air pollution from CAFOs shown to be increasing respiratory infections and other diseases in people living nearby,
• the loss of biodiversity, including the decline of farmland birds and pollinating insects,
• soil degradation and erosion from continuous monoculture crop production,
• the human health costs to employees working in stressful conditions in food processing plants.

The American Farmland Trust and Growing Food Connections have published GROWING LOCAL: A Community Guide to Planning for Agriculture and Food Systems.

This is an enormously useful how-to guide to developing local food systems with lots of facts and figures .  Here is an example:

The Federal Reserve Bank of St Louis , of all things, has issued “Harvesting Opportunity: The Power of Regional Food System Investments to Transform Communities.”

Harvesting Opportunity…highlights models for collaboration between policymakers, practitioners and the financial community, and discusses research, policy and resource gaps that, if addressed, might contribute to the success of regional food systems strategies.

New Food Economy has an analysis by Katy Kieffer on who really owns America’s farmland

While urban commercial real estate has skyrocketed in places like New York, San Francisco, and Washington, D.C., powerful investors have also sought to turn a profit by investing in the most valuable rural real estate: farmland. It’s a trend that’s driving up costs up for the people who grow our food, and—slowly—it’s started to change the economics of American agriculture.

Marion Nestle: 8 Books on Farming and Food That Deserve More Attention

May 10, 2016  EcoWatch

https://www.ecowatch.com/marion-nestle-8-books-on-farming-and-food-that-deserve-more-attention-1891129099.amp.html

I’m overwhelmed by the avalanche of outstanding books that I run across or that get sent to me. But when forced to choose, I settle on these eight as some of the best writing and original research in the bunch. They deserve much more attention than they’ve received.

1. Food, Farms and Community: Exploring Food Systems by Lisa Chase and Vern Grubinger

Many people don’t understand what food systems are and it’s very hard to explain, so this book is a terrific introduction. The authors take a big-picture approach to explain how our food gets from production to consumption. They also focus on how we can create food and farming systems that promote the health of people and planet. It’s very readable.

2. The End of Plenty: The Race to Feed a Crowded World by Joel K. Bourne, Jr.

This book takes a look at industrial farming and discusses how food production must change to meet the world’s demands. But if you think the title sounds depressing, you shouldn’t. The food situation is so much better than it was 20 years ago. There’s so much more organic, local and seasonal growing. Students are interested in these issues and that’s inspiring to me. You can make progress without overturning the whole system. My personal measure is that when we started food studies at NYU in 1996, we were the only program like that in the country. Now every university offers food studies and has an organic garden.

3. From Field to Fork: Food Ethics for Everyone by Paul Thompson

Ethical dilemmas impact the way we shop for food. Should we buy organic or local? Should we care how farm animals are raised? For people who aren’t trained in ethics, it’s sometimes hard to think about these things and this book can help you delve into them.

4. Organic Struggle: The Movement for Sustainable Agriculture in the United States by Brian K. Obach

For me, the discussion of the development of the organic standards is the most interesting part of this book. It explains why it’s so important to maintain strict organic standards and why there’s such intense conflict about them. In fact, the biggest issue facing the organic industry is confidence in the standards.

5. Afro-Vegan: Farm-Fresh African, Caribbean & Southern Flavors Remixed by Bryant Terry

Terry is an extraordinary cook. He’s really concerned about the health of African Americans, who tend to have much higher levels of chronic disease, so he sets out to demonstrate that it’s possible to cook a healthier, vegan diet using the ingredients of traditional African cuisine, like collards, grits and okra. I’ve never seen a book like this before.

6. Lentil Underground: Renegade Farmers and the Future of Food in America by Liz Carlisle

Carlisle is an incredible author (and Michael Pollan’s protégé). To write the book, she simply went to talk to farmers in Montana to find out what they were doing. It’s very lively. I attended her book tour and she actually brought the farmers with her—it was clear she was really passionate. Everyone is always talking about how farmers are failing, but this is a success story. It’s inspiring.

7. Breadlines Knee-Deep in Wheat: Food Assistance in the Great Depression by Janet Poppendieck

I have special interest in this one—I wrote the foreword. The author is fabulous and this book is particularly well done. Anyone who wants to really understand the Farm Bill and the fight about food stamps needs to read this book. We’re seeing enormous congressional fighting over SNAP right now and those same issues were there from the very beginning.

8. Lethal but Legal: Corporations, Consumption and Protecting Public Health by Nick Freudenberg

This book is compelling because it draws out the parallels between food issues and things like cigarettes, guns and alcohol. Food producers use the same corporate strategies as these other industries to enrich themselves at the expense of public health. I believe advocacy is the only way to beat the system and Freudenberg writes about ways for organizing against corporate power to create a healthier environment, organize against corporate power for a healthier, more sustainable environment.

This is one of Food Navigator’s collection of articles, videos, and podcasts on single topics, in this case “clean” labels, clearly a hot trend.

Special Edition: Where next for clean label?

How is the ‘clean-label’ trend evolving? Is it still about avoiding certain ‘artificial’ or ‘artificial-sounding’ ingredients, or is it now part of a broader conversation about GMOs, animal welfare, sustainability, and business ethics? What do consumers understand by ‘clean’ food? And how will they view innovations from monk fruit produced from microbes, to ‘meat’ and ‘milk’ made without raising animals?

To the casual observer, ‘cleaning up’ our food sounds like an eminently sensible thing to do. But where is the clean label trend going, and is ditching every ingredient you can’t pronounce really the key to fixing the ‘broken’ food system (as Panera implies in a recent ad) or improving the health of people and the planet? .. Read

• CLEAN LABEL 2.0: Natural flavors and preservatives, pesticide residues, and Non-GMO in the spotlight: Think ‘clean label’ just means ditching ‘artificial’ ingredients and avoiding anything attracting negative press (warranted or otherwise)? Think again. Today, brands are also questioning whether ‘natural’ flavors, preservatives and sweeteners are really ‘clean,’ whether Non-GMO claims should only apply to what’s in the final product, and whether pesticide residues – even at trace levels – belong in ‘natural’ or ‘clean label’ foods. So where will this all lead?.. Read
• Clean label: What works, what doesn’t, where is it headed, and what are the legal vulnerabilities?: The clean label movement may have started as industry’s response to consumers who wanted foods and beverages made without artificial or “chemical” sounding ingredients, but overtime as brands continued to one-up each other, the concept morphed and metastasized to represent so much more… Read
• SmartLabel gains traction as a tool for brands to meet consumers’ mounting clean label demands: While SmartLabel is still in its relative infancy, manufacturers are flocking to the technology to help them provide the in-depth information that today’s consumers want as part of the clean label movement, but which might not fit on product packaging… Watch now
• Arctic Zero’s new social media video campaign shows how ‘clean label’ is more than just ‘free-from’: With the launch of four new varieties, Arctic Zero produced a video to tell consumers the story of how the ingredients were sourced… Watch now
• Soup-To-Nuts Podcast: Clean label 2.0 and other top marketing strategies for natural products: When it comes to marketing products in the natural channel it seems like there are as many strategies as there are products; but just like how not all products resonate with all consumers, not all marketing strategies do either. .. Listen now
• BioChecked founder: ‘We knew non glyphosate certification was going to be something people look for’: After observing trade shows, lab test requests, and online forums on food and health, BioChecked executive director Scott Prentice and his team thought the timing was right to launch a ‘non glyphosate’ certification… Read
• Campbell Soup backs ‘potassium salt’ petition: A more consumer-friendly name will ‘advance public health goals’: Campbell Soup has joined a growing number of food manufacturers backing a citizen’s petition from NuTek Food Science asking the FDA to allow ‘potassium salt’ as an alternate name for potassium chloride on food labels… Read
• Spindrift CEO: ‘We have all the makings of a brand that can be disruptive’: Multinationals are investing in – or snapping up – smaller, more entrepreneurial brands in the natural and organic food and beverage space faster than you can say ‘because that’s where the growth is’. So will Spindrift – which is on a mission to disrupt the sparkling water category – be next on Big Food’s shopping list?.. Read
• Propylene glycol in the spotlight as Hint Water is targeted in ‘all-natural’ lawsuit with a new twist: Propylene glycol (PG) is an FDA-approved synthetic substance widely used as a solvent in ‘natural flavors’- which are clearly defined in law. But would consumers expect to find it in a product marketed as ‘all-natural’ – a term that doesn’t have a clear legal definition? Not according to a class action lawsuit filed against Hint Inc this week… Read
• Consumer interpretation of clean label trend varies by generation: As the concept of clean label continues to evolve and transition from an industry term to one consumers understand and seek, companies should take a more sophisticated approach to the trend by accounting for how different generations prioritize and interpret it, suggests research from C&R Research. .. Read
• Clean label reformulations can buffer frozen food sales’ slow but steady decline: A slow decline is forecasted for total frozen food sales, which includes frozen dinners/entrees, pizzas, side dishes, and appetizers/snacks, according to Packaged Facts’ latest numbers… Read
• In the age of clean label, are consumers in developed markets losing interest in fortified foods? With clean label now “the most dominant trend in food and drink,” many food and beverage manufacturers are moving away from fortifying foods with minerals, vitamins and other nutritious ingredients, says Euromonitor International… Read
• Clean label trend opens up new application opportunities for citrus fiber: The quest to rid product labels of phosphates, carrageenan, titanium dioxide, mono- and di-glycerides and other substances gracing food marketers’ ‘unacceptable ingredients’ lists has created new growth opportunities for Fiberstar’s citrus fibers, which are sourced from byproducts of the juicing industry… Read