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Food is one of the most basic necessities of life. In 2006 an estimated 800 million people are suffering from under-nourishment and more than 5 million children will die as a result of under-nutrition. The 33rd Annual Session of the UN's Standing Committee on Nutrition convened in Geneva in March to consider the problem of malnutrition. For the first time this network of governments, UN agencies and non-governmental organisations focused on 'over-nutrition' as well as under-nutrition. Their concluding statement noted that 'Childhood obesity is becoming a recognized problem even in low income countries. More than a billion adults worldwide are overweight, of which 300 million are obese.1 Obesity increases the likelihood of succumbing to non-communicable diseases such as diabetes, heart disease and cancer. These contribute about 47% of the burden of disease around the world.2 300,000 people are reportedly eating themselves to death every year in the United States.3 What is new is how it is a problem in lower-income countries. With one in three men overweight or obese, and one in two women, obesity levels in South Africa are now the same as in the US.4 China already has 90 million obese people, with 200 million predicted within a decade.5 Professor Philip James, chair of an International Obesity Task Force, says 'childhood and adolescent overweight and obesity already present massive problems ... in many other parts of the developing world, which are already on the fast track to a massive explosion in type 2 diabetes. The economic burden from this will act as a brake on development, which depends on having a healthy and productive population.'6
The reasons for this explosion in obesity include physical activity and food intake. Migration into cities is resulting in less-active lifestyles, while growing consumption of processed foods is leading to higher intake of salt, sugar and fat. Today supermarkets share over 50% of global food sales, and processed food sales now account for about three-quarters of the total world food sales.7 This market is being consolidated in the hands of fewer companies, with the largest 50 accounting for almost 30% of the global packaged food retail sales.8 This is not a phenomenon limited to the industrialised world. In China, for example, food industry sales took off from under 100 billion yuan (€9.2 billion) in 1991 to well over 400 billion yuan (€37 billion) just ten years later.9 Around the world, corporations increasingly comprise the food chain. From the maxim 'we are what we eat', whether we are fat or thin, healthy or sick, hungry or well nourished, hyperactive or lethargic, corporations are involved in shaping what and who we are more than ever before.
Such power commands attention. Civil society has often questioned the role of corporations in harming our nutrition. Chemical flavours and fast-food fats, mad cows and baby-milk marketing-the issues may differ around the world but a common concern has been the use and abuse of the power that corporations have today and the varying independence of public institutions from that power. In the past three years attention on the role of companies in the obesity pandemic has grown. Companies involved in the production and marketing of products containing high levels of sugar and fat have been criticised for complicity in the pandemic. Legal challenges against fast food and fizzy drink companies led Fortune magazine to ask, 'Is fat the next tobacco?'10 Popular media also picked up on the issue, highlights including the film Super Size Me, in which the documentary maker Morgan Spurlock wrecked his body by eating nothing but McDonald's fast food for a month; and celebrity chef Jamie Oliver's TV series on school dinners in the UK. The response from the food industry was mixed. The sugar industry's trade associations lobbied hard at the World Health Assembly to prevent any agreement between governments on adopting new regulations to reduce sugar content.11 Many corporate representatives argued that food consumption is a question of individual choice and responsibility, and that, as multiple factors lead to obesity, specific food products should not be singled out for regulations on salt, sugar or fat content.
A focus on personal responsibility led to responses such as obesity reports on pupils by their schools.12 However, the argument that a principle of personal choice and responsibility should determine policy responses was somewhat hollow in relation to children bombarded by advertising. Both the 'cognitive frames' of both right and left-the 'strict father' and 'nurturing parent' mind-sets described by George Lakoff13-have a special place for intervening on the behalf of children's well-being. No surprise, then, that since 2005 a major shift in perceptions in North America and Europe seems to have occurred, with the role of the mass media and food companies in influencing children's consumption choices coming into focus. In France the government banned vending machines from schools, and the UK government announced new stringent rules on food sold in schools to be introduced during 2006. The food industry also began to respond in more positive ways. Drinks giants Cadbury Schweppes, Coca-Cola and PepsiCo agreed a deal with the William J. Clinton Foundation and the American Heart Association (AHA) so that only unsweetened juice, water and low-fat milks will be sold in elementary and middle schools across the US, with diet drinks allowed in high schools.14 The voluntary action of these companies may be partly explained by a desire to appear as responsible adult-type organisations caring for the well-being of children, and therefore reducing the extent of social concern and regulatory intervention more broadly in terms of the marketing and sale of products to children, the content of products themselves and their consumption by the wider population of adults. However, as schools are nodes, or 'connector points' in society, so it is probable that more families will be discussing obesity and fast food and so the potential for ideas and practices to change is there.
Rather than being defensive, food companies could mobilise their market position in support of nutrition goals. There are now numerous examples of corporations becoming involved in food- and nutrition-related work, including partnerships aimed at delivering food, fortifying food, and advocating healthy eating. The 'Moving the World' partnership between TNT, an express delivery and logistics services firm, and the World Food Programme (WFP) was launched in 2002, with the aim of supporting WFP's fight against world hunger through knowledge transfer, on-the-ground logistical support and advocacy work. TNT's in-kind and financial commitments (more than US$12 million in 2005) have generated 27 projects in some 60 countries, most recently also in tsunami-affected areas of South-East Asia. Not being a food company itself, TNT has less internal issues to consider in relation to food. Some food companies have, however, also begun addressing these issues, illustrated by their participation in the new 'Healthy Eating and Active Living Global Partnership' (HEAL). This initiative aims at facilitating business action as 'part of the solution to the massive increase in chronic lifestyle-related diseases around the world linked to obesity, poor diets and a lack of physical activity'.15 In March they co-published a report profiling companies that are beginning to take health issues more seriously and the business benefits of doing so.16
Yet progress is sufficient neither for public health nor for managing strategic threats and opportunities facing the food industry, according to a report published in the same month by Ethical Investment Research Services (EIRIS). 'Our research revealed little evidence of obesity-related improvement targets and key performance indicators from the multinational food and beverage firms we analysed', said report author and EIRIS research analyst Heleen Bulckens. 'Food and drink producers are waking up to the business risks associated with obesity, but significant challenges remain.'17
Those challenges are systemic. More voluntary action from companies in supporting changes in behaviour, and improving the nutritional content of their products, is needed and welcome. However, complex social, economic and cultural factors influence people's nutrition and physical activity. To achieve widespread public health benefits, and related benefits for economic activity, will require an open assessment and trial of a range of public policy tools to influence patterns of food production and consumption. It would be sensible for companies to start planning now for this healthier future.
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