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Article The World We Want In partnership with the UNDP

Policies targeting the global obesity epidemic: The definition of insanity?

Currently, the Health Survey for England shows that around 6 out of 10 adults and 3 out of 10 children (aged 2-15) are overweight or obese. The increase of high amounts of salt, sugar and fat in diets is putting people at greater risk of developing chronic diseases such as diabetes and can cause premature death. Poor nutrition contributes to approximately 30% of coronary heart disease deaths and 33% of all cancer deaths (Peterson and Rayner, 2003) (Doll and Peto, 1981). The estimated costs of overweight people on society and the economy have been estimated at almost £16 billion in 2007, with future estimates rising to £50 billion a year by 2050 if left unchecked (Department of Health RD).

However, in 2012 the United Kingdom’s (UK) Coalition Government initiated the Public Health Responsibility Deal (RD) to address these escalating health issues. This is a voluntary guideline asking food companies to pledge certain promises to make changes that they believe will reduce the amount of ill-health, chronic diseases and premature deaths due to poor diets in the UK.

The RD’s fundamental principle is to take a “partnership approach” with industry instead of state regulation (Hashem et al., 2011: 3). Here, organisations are required to sign up to a set of ‘core commitments’ and ‘supporting pledges’. But, it is facing immense criticism from a wide range of actors as voluntary guidelines to tackle serious problems, such as obesity and chronic disease, seems to be an act of ‘passing the buck’ onto the private sphere, dodging the difficult and risky decisions needed to be made by the state and not placed into the hands of the very companies who create the products attributing to the UK’s poor diet.

Additionally, these voluntary or cooperative approaches with the private sector have been preferred over implementing regulation which time and time again have demonstrated a failure in tackling public health and environmental issues. Bringing the big food companies to the table maybe necessary to achieve a more robust and holistic strategy, however, as it stands today, Governments are instead handing over the table and policy is still being driven by industry. Such agreements then put in question who is responsible and who should be held accountable for the public’s ailing health. Are the likes of Pepsi Co. or Coca Cola responsible for our health?

Individuals are most commonly, especially within the UK, given the burden of responsibility for their own health and diet choices. They are viewed as consumers instead of citizens, who make choices about what they buy, consume and whether they take part in physical activity or not in order to lead a healthier lifestyles, and these choices should not be hindered by the state. With the introduction of neo-liberal free market ideology, governments began to retreat from interfering with market forces as they were convinced that, left to its own form of self-regulation, it would function best and economic growth would be achieved. But focusing on market forces put the interest of profits and businesses above the interests of public health; framing citizens of the state as simply consumers of the market.

The UK government’s approach to public health issues, related to food, hold citizens as consumers. There is an assumption in the UK that food should be allocated to the private, domestic sphere, outside the jurisdiction of the state (Dowler and Jones, 2003). This has come to create an aloof policy environment, making it easy for companies to abuse such partnerships.

Big food companies have been able to use corporate social responsibility provisions to play one role to consumers and another to please shareholders (Schepers, 2010)(Ludwig and Nestle, 2008). Clearly, businesses have a separate agenda from the public, yet governments continue to pursue voluntary agreements.

This is why many academics and food advocates contend that the private sector cannot be trusted nor relied upon as the evidence shows they make many promises but there are many discrepancies what they actually do. But what we all need to keep in mind is that businesses exist to accumulate profits and beat out the competition in order to appease shareholders and survive.

Governments and the public need to be more realistic about their expectations for the role of the private sector as their interests will always come before those of public health at the end of the day.

With this in mind, the RD is not effective. It is missing substantial incentives or benefits to business to participate, legislation appears to be absent as an alternative, the use of quantified targets is limited and lacks disincentives or sanctions to curb non-compliance.

Sanctions and pledges

Without sanctions companies will breach provisions if they see commercial advantages in breaking them. Hashem et al. (2011) concluded from a study they conducted evaluating the effectiveness of the RD is that, in not offering the key elements mentioned above, the RDis ineffective and has demonstrated this failure as key corporations have yet to sign up or have simply signed up for pledges that have little to nothing to do with their business.

An example in Hashem et al. (2013) revealed that, although “the majority of the food and non-alcoholic beverage companies have signed up to [the reduction of trans-fats] pledge” - many of these companies do not use trans-fats in their products. This is a clear abuse of the intentions of the agreement demonstrating businesses interests and the weakness of the deal. In addition, the RD does not have clear targets and the pledges are vague, thus rendering them weak and open for such abuses.

Others criticise the RD for not providing fast enough results. According to this vein of thinking, more urgency is required as today’s health epidemic due to diet is steadily climbing and the pace at which governments are tackling it are not fast enough: “Obesity is a significant and urgent societal problem and the current RD pledge on obesity is not a proportionate response to the scale of the problem.” (Behaviour Change Report, 2011). The Which? Consumer Report (2012) also exclaimed that the current RD is failing to deliver on its promise to deliver faster and better results than through legislative or other approaches (Which?, 2012: 7).

But there may still be room for public-private relationships through Voluntary agreements. Effective Voluntary agreements and partnerships can help both parties be more efficient and successful through cooperation and settlement on targets, improve data sharing, shared financial resources and expertise, and coordination of efforts to reduce duplication.

The focus needs to be shifted to address the systemic issues of poor diets; food prices, poverty, access, subsidies, food environments, availability and so forth. All sectors and levels of governance need to take responsibilities within their role, and help to empower individuals with the right resources, opportunities, and living conditions to enable them to achieve a healthier lifestyle, which a more effective partnerships could achieve.

The need for effective public health policies has never been greater, and systemic issues that affect access to adequate healthy diets need to be addressed in a multi-faceted and multi-levelled governance approach. However, approaches such as the RD is not yet up to the task. While cooperation and coordination across public, private and non-profit sectors, across all levels of governance; community, regional, national, and global, is key to tackling issues dealing with health and our food system, what is needed is for the government to reclaim its role as protectors of the state and the citizens (not consumers) within it from the interests of actors who may harm the public’s wellbeing in seeking out their own interests, yet at the same time creating an atmosphere conducive to collaboration to entice these actors to comply with new regulations, without too much cost to either party. Individual behavioural changes can only be achieved in an environment that is supportive to a healthier lifestyle therefore requiring a more dynamic and multi-faceted approach.

In addition, better planning in order to establish clearer, more ambitious targets with stricter guidelines, and disincentives or sanctions for non-compliance should be established as so well concluded by a study conducted by Bryden et al. (2013). Although a favourite rebuttle against threats of regulation by food retailers and processors is the consideration of impeding individual choice, governments have always had to implement tough regulations upon the private sphere in order to curb safety and environmental issues. A prime example are regulations placed on automobile production and use – the safety features and requirements for wearing seat belts, keeping up with safety tests and licencing etc. Our food system is killing more people today than ever in a car accident.

Government and the public need to have a more realistic perspective of the role and objective of the private sphere; businesses exist to make profits and pay shareholder, not to provide social welfare, nor will they put public health interest above their own goals as they too must survive in the very competitive market. The evidence speaks loudly that without taking greater responsibility and acting urgently many more lives will be lost (Hashem et al., 2011).

Confronting the obesity and public health epidemic due to poor diets in the UK is not an insurmountable task, but requires new frameworks to be undertaken to move from narrow initiatives focusing on changing individual behaviour. Placing all responsibility into the hands of citizens is irresponsible and ignorant. There are many systemic problems that make it difficult for people to achieve a healthy and adequate diet such as poverty, physical access, and other socio-cultural factors.

More research

More funding into researching new policy models and information about health, illness and how it relates to our diets would help counter balance the current unlevelled playing field in which companies are able to fund and market their conclusions which tend to produce outcomes more in their favour (Ludwig and Nestle, 2008). Governments can no longer afford to pass off the responsibility of dealing with our broken food system, no matter how daunting the task.

Continuing to approach the public health epidemic due to poor diets in the same, failing manner is insane. What is needed is an innovative, holistic approach by incorporating the recommended actions mentioned above that would enable governments to make more successful partnerships between the public and private sphere, thus reducing time, cost and reduce public pressures as well as achieve great progress in creating a better, healthier future for its citizens, economy and self.

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