“How much longer do we have to go on failing, before we decide to do something different?”
That was the question posed by Professor Jack Winkler at a recent symposium on ‘Sugar, Fat, and the Public Health Crisis’. Speaking at the event the policy expert said that the options available to policy makers and governments are severely restricted, but added that there is hope that working with industry in a ‘pragmatic approach’ could lead to success in dealing with growing issues in public health.
“Diabetes rates are growing rapidly all over the world,” said Winkler. “If diabetes continues to grow the way it has, it will put an intolerable burden on any healthcare system in the world.”
“When dealing with these problems, diets don’t work. Education doesn’t work either,” he warned, citing recent studies by the WHO and OECD.
“We have failed to get people to eat different, healthier foods, so the option that is left to us is to deal with the foods that most people eat and then improve the nutritional quality of those foods.”
Failed strategies
Winkler said these studies reveal that the overwhelming nutrition policy in all countries studied for the last 30 years has been educational programmes directed at consumers.
“That strategy has failed. Everywhere, people have got fatter and fatter.”
The problem, he suggested, is “processed foods, the greedy companies that make them, and the cowardly governments that fail to control them.”
“You get less calories per penny with ‘real food’ than you do with processed food,” he said. “You get a lot more energy for your pound if you buy custard creams than if you buy broccoli.”
“What we have therefore is a big majority of people who either do not want or cannot afford to eat different foods, however real or healthy they may be.”
However, Winkler also noted ‘substantial’ improvements in the nutritional content of processed foods in recent years – leading some people to argue that the food we eat now is much better than in the past.
Politically impossible
Winkler outlined three alternative strategies that could work ‘in theory’. These are:
- Altering agricultural policy
- Taxation on foods
- Regulation
“These are the three basic options for nutrition policy,” he said. “In principle all of them are possible. In practise all of them are either technically ineffective, politically impossible, or both.”
Speaking of the challenges in altering agricultural policy, Winkler said that such policies are “one of the most politically difficult areas to change.”
Whilst the option to tax bad foods – especially sugars and soft drinks – may be attractive to some, Winkler noted research that recently concluded a 10% tax on soft drinks would only reduce consumption by 7.5ml per person per day.
“That’s less than a sip,” commented the expert, who said that taxation is “dead as a political option” in addition to being ineffective.
Winkler said that the Anglo-Saxon distain for taxation has led to sugar taxes being consistently voted down in the US, UK, and Europe. Indeed he noted that in Denmark a tax on sugar introduced last year was recently repealed.
“If you look at that from a politician’s perspective; there is not any politician, in any party, who would go anywhere a tax on bad foods for the foreseeable future.”
Brussels bureaucracy
Tighter regulation are a 'plausible option' to drive changes, he said. However it is an option that is fraught with political and practical problems.
“Governments do not see regulation as a means of consumer protection,” said Winkler, who added that in the EU, food and food law is an ‘EU competancy’ that is not decided by member states, but in Brussels.
“One of the difficulties when you have 27 member states is deciding on which rules you want to make up the new regulations.”
“Consider the most famous one in recent times: health claims,” he said. “The commission began working on health claims in the late 1970s, it is now 2013 and we still are not finished yet.”
“Forty years and counting. Without any rules for the game.”
Pragmatic approach
“We have to start from where we are now, not where we would like to be,” stated Winkler – adding that around 85% of food people eat is processed, and the nutrient profiles of those products are determined by the manufacturers.
“That is to say that the nutritional quality of these products influences the nutritional status of the nation – for good or for ill.”
“Rather than trying to change the people, we change the foods instead.”
“We need to reformulate the popular, mass market foods that people actually eat.”
This means two things, according to Winkler: taking out the bad ingredients like sugar or salt, or putting in good ingredients like omega-3 long chain fatty acids.In this sense, he said that reformulation and fortification has gone ‘horribly wrong’ on occasions in the past. “But it can also go right”
“The greatest public health strategy of the 21st century is a fortified food – namely, iodised salt,” he said. "The big issue however is reducing the excessive ingredients – sugar, and others.”