by Marion Nestle

Currently browsing posts about: Public-health

Mar 28 2023

The Lancet series on commercial determinants of health (and, therefore, nutrition)

Executive Summary

Commercial actors can contribute positively to health and society, and many do, providing essential products and services. However, a substantial group of commercial actors are escalating avoidable levels of ill health, planetary damage, and inequity—the commercial determinants of health. While policy solutions are available, they are not currently being implemented, and the costs of harm caused by some products and practices are coming at a great cost to individuals and society.

A new Lancet Series on the commercial determinants of health provides recommendations and frameworks to foster a better understanding of the diversity of the commercial world, potential pathways to health harms or benefits, and the need for regulatory action and investment in enterprises that advance health, wellbeing, equity, and society.

  • Defining and conceptualising the commercial determinants of health: Anna B Gilmore, Alice Fabbri, Fran Baum, Adam Bertscher, Krista Bondy, Ha-Joon Chang, Sandro Demaio, Agnes Erzse, Nicholas Freudenberg, Sharon Friel, Karen J Hofman, Paula Johns, Safura Abdool Karim, Jennifer Lacy-Nichols, Camila Maranha Paes de Carvalho, Robert Marten, Martin McKee, Mark Petticrew, Lindsay Robertson, Viroj Tangcharoensathien, Anne Marie Thow

Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors—notably the largest transnational corporations—are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so….

Most public health research on the commercial determinants of health (CDOH) to date has focused on a narrow segment of commercial actors. These actors are generally the transnational corporations producing so-called unhealthy commodities such as tobacco, alcohol, and ultra-processed foods….Moving forward, it is necessary to develop a nuanced understanding of commercial entities that goes beyond this narrow focus, enabling the consideration of a fuller range of commercial entities and the features that characterise and distinguish them…Improved differentiation among commercial actors strengthens the capacity of practitioners, advocates, academics, regulators, and policy makers to make decisions about, to better understand, and to respond to the CDOH through research, engagement, disengagement, regulation, and strategic opposition.

This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health—the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.

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For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

 

Dec 13 2022

Healthy People 2030 releases early progress report

Healthy People 2030 has released its latest set of tracking data.  This, you will recall, is the latest of the US Public Health Service’s 10-year plans for improving the health of Americans.  The agencies involved set specific, measurable objectives and track progress toward achieving them.

You can browse the full set of objectives here.

The objectives for overweight and obesity are here.  Three have tracking data available.  Of these,

One shows no change: Reduce the proportion of children and adolescents with obesity — NWS‑04

Two are getting worse

The objectives for Nutrition and Healthy Eating are here.

Of the objectives with data available, two showi improvement!

Three show no change:

Two (plus the obesity one above) are getting worse:

Sep 14 2022

PepsiCo’ push into regenerative agriculture: real or greenwashing?

Thanks to Hugh Joseph for sending this piece on PepsiCo’s commitment to regenerative agriculture in its supply chains: From regenerative ag to reformulation: A deep-dive into how PepsiCo is ‘reimagining the way food is grown, made and enjoyed’

When PepsiCo launched Pep+ in October 2021, the company said it wanted to ‘fundamentally change’ how it does business for the betterment of people and planet​. From ingredient sourcing and production to supporting consumers make choices that are ‘better for themselves and the planet’, Pep+ outlined an ambitious agenda of business transformation.  The company wants to:

  •  Spur transition to regenerative practices across land that is equivalent to its entire agricultural footprint, approximately seven million acres.
  • Reduce reliance on chemical inputs (but does not rule out their use).
  • Secure the future of farming communities and farmer incomes.
  • Support farmers by helping them with high fuel and fertilizer costs.
  • Support rural communities – and female farmers in particular.
  • Transition towards more than 70% of the company’s global electricity needs in direct operations are met by renewables.
  • Reach net zero emissions by 2040.
  • Improved operational water-use efficiency by 18% in high water-risk areas.
  • Use 100% rPET by the end of this year, contributing to 87% of PepsiCo-owned drinks portfolio in the European Union being made using 100% recycled or renewable plastic.
  • Eliminate virgin fossil-based plastic in all crisp and chip bags..

And then there are Pepsi’s nutrition objectives [recall: Pepsi makes snack brands like Walkers and Dorito alongside its line-up of fizzy drinks].

Use more chickpeas, plant-based proteins and wholegrains.

Expand nuts and seeds category.

In Europe, cut added sugars in its soft drinks by 50% .

Improve the nutritional quality of snack products.

My questions:

  • Is this real or greenwashing and healthwashing?
  • Who is holding Pepsi accountable for achieving these objectives?

The larger question is whether Pepsi’s portfolio of snack foods and sugary drinks can ever be sustainable?

In 2011, I was quoted in a New Yorker article about Pepsi’s health initiatives.

As part of PepsiCo’s commitment to being “the good company,” the corporation wants to play a leading role in public-health issues, and particularly in the battle against obesity. Some people think this is ludicrous. Marion Nestle, the author of “Food Politics” and a professor of food studies at N.Y.U., told me, “The best thing Pepsi could do for worldwide obesity would be to go out of business.”

I probably wouldn’t use the word ludicrous (and I’m not sure I did then), but the effort was certainly unrealistic.

Like all publicly traded corporations, PepsiCo is heavily constrained by shareholder profit objectives.

A decade ago, its shareholders objected to a focus on public health when sales of Pepsi declined.

Has anything changed since then?

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Coming soon!  My memoir, October 4.

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

 

Jun 10 2022

Weekend reading: Using comics to promote public health

Meredith Li-Vollmer.  Graphic Public Health.  Penn State University Press, 2022.

Probably because of my cartoon book, Eat, Drink, Vote: An Illustrated Guide to Food Politics, I was asked to do a blurb for this book, which I was happy to do.

In her thoroughly up-to-date, informative, and useful book, Li-Vollmer convincingly argues for the effectiveness of comics in conveying health risks and desired behaviors.  She proves this point with splendid and deeply engaging examples, and provides an instructive how-to for creating your own. This book should be in every public health curriculum; it’s not only informative but also wonderful fun to read.

They only used the sentence in bold face (edited to convert wonderful to wonderfully).

But the rest explains why I think the book is worth reading.   Li-Vollmer works for Seattle’s health department and discovered comics as a way of communicating public health messages.  The book includes lots of examples of the work of comic artists explaining issues related to a host of public health issues.  Although none of the examples focus specifically on food issues, some briefly cover food safety, eating watery foods on hot days, and how climate change affects food production.

I think this is a great way to communicate public health issues.  New York City subway rider that I am, I greatly enjoyed the AIDS story that the New York City Health Department told in posters in the early 1990s.  As the New York Times explained,

Our story so far, as seen in 6,000 New York City subway cars, above the windows and between the advertisements for hemorrhoid, hernia, and foot doctors:

Julio and Marisol run into each other while visiting Raul Rodriguez, who is in the hospital with AIDS. They apologize for the big quarrel several episodes back, when Julio refused to use a condom and walked out. Their romance rekindled, they leave Raul’s room to get some coffee and talk things over.

Suddenly, Rosa bursts in. “I’m scared,” she tells Raul. “I’m . . . I’m . . . I’m H.I.V. positive.”

Mar 24 2021

My latest publication: a book review

I’ve just had a book review published in the American Journal of Public Health: “Public health nutrition deserves more attention.”

It’s for a textbook on public health nutrition but doing it gave me the opportunity to say some things I want public health professionals to know.  I started the review like this:

Public Health Nutrition deserves more attention

Food and nutrition deserve much more attention from public health professionals.  On the grounds of prevalence alone, diet-related conditions affect enormous numbers of people.  Everybody eats.  Everybody is at risk of eating too little for health or survival, or too much to the point of weight gain and increased prevalence of non-communicable diseases (NCDs).  By the latest count, nearly 700 million people in the world do not get enough to eat on a daily basis, a number that has increased by tens of millions over the past five years and will surely increase by many millions more as a result of the Coronavirus pandemic.[i]   At the same time, about two billion adults are overweight or obese, and few countries are prepared to deal with the resulting onslaught of type 2 diabetes and heart disease.[ii]  Beyond that, food production, distribution, consumption, and disposal—collectively food systems—are responsible for a quarter or more of greenhouse gas emissions; climate change affects the health of everyone on the planet.[iii]

The same social, behavioral, economic, and structural determinants that affect health also affect nutritional health, and it is no accident that food choices are flash points for arguments about culture, identity, social class, inequity, and power, as well as about the role of government, private enterprise, and civil society in food systems.   From a public health standpoint, everyone–regardless of income, class, race, gender, or age—should have the power to choose diets that meet nutritional needs, promote health and longevity, protect the environment, and are affordable, culturally appropriate, and delicious.

Nutrition in 2021

For people in high-income countries, dietary prescriptions for health and sustainability advise eating less meat but more foods from plant sources.[iv]  Optimal diets should minimize consumption of ultra-processed foods, those that are industrially produced, bear little resemblance to the basic foods from which they were derived, cannot be prepared in home kitchens, and are now compellingly associated with NCD risk and mortality.[v]  We now know that ultra-processed foods encourage people to unwittingly take in more calories and gain weight.[vi]

Agenda for 2021

Today, a book for researchers and practitioners of public health nutrition needs to emphasize coordinated—triple-duty—recommendations and interventions to deal with hunger and food insecurity, obesity and its consequences, and the effects of food production and dietary choices on the environment.  Such approaches, as described by a Lancet Commission early in 2019,4 should encourage populations of high-income countries to eat less meat but more vegetables, those in lower- and middle-income countries (LMICs) to consume a greater variety of foods, and everyone, everywhere to reduce intake of ultra-processed foods.  As that Commission argued, public health nutritionists must recognize that attempts to improve diets, nutritional status, nutritional inequities, and food systems face daunting barriers from governments captured by corporations, civil society too weak to demand more democratic institutions, and food companies granted far too much power to prioritize profits at the expense of public health.  Nutritionists need knowledge and the tools to resist food company marketing and lobbying, to advocate for regulatory controls of those practices, and to promote civil society actions to demand healthier and more sustainable food systems.[vii]

I then go on to talk about the book itself, which alas, did not have much to say about this agenda.

References to the first part of this review

[i] The World Bank.  Brief: Food Security and COVID-19. December 14, 2020. https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19#:~:text=In%20November%202020%2C%20the%20U.N.,insecure%20people%20in%20the%20world. Accessed January 2, 2021.

[ii] WHO.  Obesity and overweight: Key facts.  Geneva: WHO.  April 1, 2020. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed January 2, 2021.

[iii] International Panel of Experts on Sustainable Food Systems. COVID-19 and the crisis in food systems: symptoms, causes, and potential solutions. IPES-Food, April 2020. www.ipesfood.org/pages/covid19. Accessed January 2, 2021.

[iv] Swinburn BA, Kraak V, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet. 2019;393:791–846.

[v]  Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–941.

[vi] Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019;30, 67–77.

[vii]  Jayaraman S, De Master K, eds.  Bite Back: People Taking On Corporate Food and Winning.  Oakland, CA: University of California Press; 2020.

 

 

Feb 12 2021

Weekend reading: Lancet Commission Report on Public Policy and Health in the Trump Era

Yesterday, the Lancet Commission on Public Policy and Health in the Trump Era published the report of its four-year investigations.  I was a member of the Commission, so have a special interest in this report.

The Executive Summary  

Convened shortly after President Trump’s inauguration in 2017, the Lancet Commission on public policy and health in the Trump era, offers the first comprehensive assessment of the detrimental legislation and executive actions during Trump’s presidency with devastating effects on every aspect of health in the USA. The Lancet Commission traces the decades of policy failures that preceded and fueled Trump’s ascent and left the USA lagging behind other high-income nations on life expectancy. The report warns that a return to pre-Trump era policies is not enough to protect health. Instead, sweeping reforms are needed to redress long-standing racism, weakened social and health safety nets that have deepened inequality, and calls on the important role of health professionals in advocating for health care reform in the USA.

The bottom line (as stated by Dr. Kevin Grumbach in the announcement video): “Trump committed medical malpractice.”

The Commission’s process

Commission members were appointed in 2017, met in Atlanta soon after, held a conference at Boston University in 2018, and met again early in 2019.  I drafted the section on food and nutrition, no surprise, and also worked on the box on what happened in Puerto Rico, in which I have a particular interest (I taught a class there in 2003 with the anthropologist, Sidney Mintz, who wrote Sweetness and Power).  Other members drafted other parts.  The co-chairs, Steffie Woolhandler and David Himmelstein, pulled it all together and established its direction and voice.  Food politics is a small part of this report (see section 6), but I was happy to get it included.  It gave me a chance to complain, once again, about the forced move of the USDA’s Economic Research Service to Kansas City, something I consider to be a national tragedy, and to talk about how the Trump Administration attempted to destroy SNAP and undermine school meal standards.

The report, associated documents, and announcement video are on this Lancet website 

It got a lot of press—news accounts and opinion pieces (the full list as of February 27 is here)

Jan 8 2021

Weekend reading: wishes for the new year

I am a big fan of Howard Bauchner, the editor-in-chief of JAMA, who not only promotes science but also seems to have a lot of integrity.  I think it’s worth reading his new year’s wish list for medicine and science.

What concerns him, and what’s on his list applies just as well to food and nutrition.  He says, for example,

An increasingly important question is whether, in a country in which “profit” dominates, it will be possible to have a fair and equitable health care system. Has profit, self-interest, and greed come to dominate the landscape of US medicine? And as the Great Pandemic of 2020 has demonstrated, health care disparities remain a fundamental problem in the US health care system.

Here are some of the items on his wish list:

  • Respect for science, the individuals who pursue scientific discovery, and the federal agencies that support and conduct scientific research.
  • A comprehensive, coordinated, and effective national response to the COVID-19 pandemic, driven by science and evidence, and based on solid clinical and public health principles, including prevention and widespread vaccination.
  • A true national commitment to health care as a right and not a privilege.
  • A national debate about a single-payer (Medicare for All), universal health plan that includes private insurers, a public option, further expansion of Medicaid, and lowering the age of Medicare to 60 years.
  • Reducing administrative costs and eliminating barriers to health care access to ensure that millions of individuals can be insured without increasing overall health care costs.
  • A national campaign to identify and treat every individual with hypertension in the US.
  • That the US returns to a time of civility, healthy debate, and respect for the opinions of others.

Amen.

And to his final comment—“This list is my hope for 2021 and beyond: a respect for science, scientists, and public health officials, healthy and civil debate, and a fundamental commitment that no individual in the US should be without health insurance”—I would add: a food system designed to prevent food insecurity and promote health for people and the environment.

Jun 11 2019

My latest publication: food and nutrition policy primer

How the US food system affects public health is a matter of intense current interest. “Food system” means the totality of processes through which food is produced, transported, sold, prepared, consumed, and wasted.4 Policies governing these processes emerged piecemeal over the past century in response to specific problems as they arose, with regulatory authority assigned to whatever agency seemed most appropriate at the time.5 Today, multiple federal agencies oversee food policies. For some policy areas, oversight is split among several agencies—the antithesis of a systems approach.

US food policies deal with eight distinct purposes, all of them directly relevant to public health:

  • Agricultural support: Overseen by the US Department of Agriculture (USDA), agricultural support polices are governed by farm bills passed every five years or so. These bills determine what crops are raised and grown, how sustainably, and the extent to which production methods contribute to pollution and greenhouse gas emissions.
  • Food assistance: The USDA also administers food assistance for low-income Americans through programs such as the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), the Women, Infants, and Children program, and school meals.
  • Nutrition education: This policy is set forth in dietary guidelines revised every five years since 1980 (overseen jointly by the USDA and the US Department of Health and Human Services) and in the MyPlate food guide (USDA).
  • Food and nutrition research: The National Institutes of Health and the USDA fund studies of diet and disease risk.
  • Nutrition monitoring: The USDA and the Centers for Disease Control and Prevention are responsible for keeping track of the quantity and quality of the foods we eat and how diet affects our health.
  • Food product regulation: Rules about food labels, health claims, and product contents are overseen by three agencies: the USDA for meat and poultry; the Food and Drug Administration (FDA) for other foods, beverages, and dietary supplements; and the Federal Trade Commission for advertising.
  • Food safety: Regulation of food safety is split between the USDA for meat and poultry and the FDA for other foods.
  • Food trade: More than 20 federal agencies are involved in regulating the export and import of food commodities and products, among them are the FDA, the USDA, and the Department of Homeland Security.

This list alone explains why advocates call for a coordinated national food policy.6

The food policy primers in this issue of AJPH address the critical links between agricultural policies and health (Miller et al., p. 986) and key components of food assistance policies: direct food aid to the poor (Brownell et al., p. 988) and nutrition standards for school food (Schwartz et al., p. 989). Their authors are well-established policy experts whose thoughtful comments on the political opposition these programs face make it clear why food system approaches to addressing hunger, obesity, and climate change are essential.

Politics stands in the way of rational policy development, as the editorial by Franckle et al. (p. 992) suggests. Although its authors found substantial bipartisan support for introducing incentives to improve the nutritional quality of foods purchased by SNAP participants, congressional interest in this program remains focused almost entirely on reducing enrollments and costs. Please note that for a special issue of AJPH next year, I am guest editing a series of articles on SNAP that will provide deeper analyses of that program’s history, achievements, needs for improvement, and politics. Stay tuned.

In the meantime, how can US public health advocates achieve a systems approach to oversight of the eight food and nutrition policy areas? A recent report in the Lancet suggests a roadmap for action. It urges adoption of “triple-duty” policies that address hunger, obesity, and the effects of agricultural production on climate change simultaneously.7 For example, a largely—but not necessarily exclusively—plant-based diet serves all three purposes, and all federal food policies and programs, including SNAP, should support it. The primers and editorial should get us thinking about how to advocate a range of food system policies that do a better job of promoting public health. Read on.

CONFLICTS OF INTEREST: The author’s work is supported by New York University retirement funds, book royalties, and honoraria for lectures about matters relevant to this comment.

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