The causes of noncommunicable diseases (NCDs) are many and varied. Some are environmental, including indoor and outdoor air pollution. Some are genetic, such as for select cases of type one diabetes. Many more are the result of the decisions people make and behaviours they engage in, including tobacco use or the harmful use of alcohol. Whatever the root, every year NCDs kill 8.9 million people across the WHO South-East Asia Region, with 4.4 million succumbing to them prematurely. That is of deep concern.
A critical factor in the battle against NCDs, which is one of the Region’s Flagship Priorities, is the food systems people are part of and the outcomes they have. At the country, regional and global levels, for example, food systems define the food environment, which consists of the physical, economic, policy and socio-cultural conditions that shape people’s dietary choices and nutritional status, including malnutrition of all types, whether underweight, overweight or obesity. In other words, food systems and the environments they create define the way in which risks associated with several NCDs – from diabetes to heart disease and hypertension to cancer – are managed and mitigated or allowed to grow.
Member States across the Region recognize this: Each has now incorporated food environment-related policies in its National NCD Action Plan and is implementing high-impact legislation to drive transformative progress.
In 2016, for example, Sri Lanka pioneered a ‘traffic light’ labelling system for all beverages sold in the country, creating a simple way for consumers to be made aware of the sugar contained in pre-packaged drinks and make informed decisions to regulate their consumption. In the same year Maldives hiked taxes on energy and soft drinks by a massive 58% – the single greatest increase anywhere in the world. India has meanwhile reduced the amount of trans-fats permissible in food products to 5%, while Thailand has passed legislation in line with the International Code of Marketing of Breast-Milk Substitutes. It is also working with industry to limit the salt content of a range of foods. –
Though these and similar interventions are to be commended, further progress is needed to achieve the Region-wide target of a one-fourth reduction in premature NCD deaths by 2025 and a one-third reduction by 2030. As the Sustainable Development Goals outline, and as the UN Decade of Action on Nutrition emphasizes, all countries have a unique opportunity to enhance multisectoral engagement to create more sustainable food systems that promote health and decrease the risk of NCDs throughout the life-course.
A great place to start is by communicating effectively to increase health literacy and improve dietary habits. This requires health authorities to identify key problem areas where changes in consumption will have optimal impact on health outcomes, be that by decreasing salt intake, reducing the consumption of sugar-sweetened beverages, cutting the intake of fatty foods, or simply promoting the benefits of a healthy diet. It also requires them to devise simple, comprehensible messaging that is culturally relevant, credible, actionable and accessible to all.
Member States should likewise consider new ways to engage food industries to public advantage. Governments have immense capacity, for example, to establish norms and standards for the nutrients food and beverages contain, and to help reformulate their content accordingly. They should ensure this capacity is put to full use. Importantly, at the same time as disseminating these norms and standards and supporting manufacturers adhere to them, where appropriate, it is vital they are enforced and are not merely seen as ‘opt-in’ measures that can be adopted at will. Innovative measures to promote healthier street food should likewise be pursued.
Monitoring and evaluating efforts to adapt food systems should be a top priority. Clear indicators have been set in several areas to facilitate this, including the 2025 goals of achieving a 30% relative reduction in sodium intake, halting the rise of obesity and diabetes and reducing the prevalence of raised blood pressure by 25%. As part of this drive – and to gain a fuller picture of what is or isn’t working – countries should also measure the impact their broader agri-food systems are having on NCDs, at the same time as considering how they can accelerate progress towards each of their targets.
WHO remains committed to working with Member States Region-wide – alongside key partners at all levels – to consolidate Member States’ many gains, including via innovative policies that empower individuals, communities and countries. That is, after all, what the food systems approach to NCDs is all about. More than anywhere else, food systems across the Region are changing, offering the potential to wipe-out hunger and underweight, but also increasing the risk of overweight, obesity and associated NCDs. That is both inspiring and cause for concern. Given this reality, harnessing the food systems approach to tackle NCDs is not simply a matter of good policy. It is a matter of need.
Contributed by Dr Poonam Khetrapal Singh
WHO Regional Director for South-East Asia