THE WORLD is facing an epidemic of chronic illnesses. Every year 46 million people die from cardiovascular and respiratory diseases, cancers, diabetes, obesity and other noncommunicable conditions – almost 60 per cent of all deaths.
The problem is no longer confined to rich countries. Most of the deaths from these diseases now occur in the developing world, which is increasingly suffering as a result of the transition towards sedentary lifestyles and a diet high in sugars, saturated fats and salt and low in nutrients. Cases of cardiovascular disease are already more numerous in India and China than in all economically developed countries combined.
One of the most significant things about this toll of death and disability is that it is preventable. The major causes of chronic diseases are high blood pressure, high cholesterol, smoking, obesity and alcohol. Most of the damage could be prevented through simple changes in diet, by being more active and by not smoking.
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This month, the World Health Organization (WHO) will adopt a Framework Convention on Tobacco Control, which will lead to even more action to stem the impact of one of the risks. We are now addressing the two other major factors in the rise of chronic diseases: unhealthy diet and physical inactivity. Last week, the WHO and the UN Food and Agriculture Organization (FAO) launched Diet, Nutrition and the Prevention of Chronic Diseases. This is the report of a joint consultation involving more than 60 experts over two years, and it contains the best currently available scientific evidence on the relationship between diet, nutrition, physical activity and chronic diseases.
It emphasises that a diet low in saturated fats, sugars and salt, and high in vegetables and fruits, together with an increase in physical activity, would considerably reduce this toll of death and disease. The report’s goals include limiting fat to between 15 and 30 per cent of total daily energy intake, and saturated fats to less than 10 per cent. It suggests that carbohydrates should provide the bulk of energy requirements – between 55 and 75 per cent of daily intake – and that people should restrict their intake of salt to less than 5 grams a day, and eat at least 400 grams of fruit and vegetables every day. It also notes that, ideally, people should spend 1 hour on most days of the week engaged in moderate-intensity activity, such as brisk walking.
But what drew most attention when the report was launched was the recommendation that sugar should provide no more than 10 per cent of the energy in people’s diets. The US-based Sugar Association and the World Sugar Research Organization, which represent the interests of sugar growers and refiners, mounted a strong lobbying campaign in an attempt to discredit the report and suppress its release.
This pressure comes despite the fact that the recommendation is not new. It is based on the vast scientific evidence on the effect of sugars on the prevalence of chronic diseases globally. The same recommendation appeared in the previous WHO technical report in 1990. At least 23 national reports have set targets for added sugars at an average of 10 per cent or less.
The development of the WHO/FAO report was highly transparent. Such technical reports are usually confined to the experts, but in this case, recognising the increased interest in diet and obesity, we organised consultations with industry and representatives of non-governmental organisations, and made a draft of the report available on our website months before it was published.
We received more than 120 outside comments – including submissions from at least 20 organisations connected with sugar. These comments were all made public on our website, and all the input was reviewed by the experts involved in finalising the report. The experts considered the sugar industry’s arguments for changing the recommendation, but did not see them as scientifically credible. The Sugar Association responded by publicly threatening to lobby the US Congress to reduce funding for the WHO.
In recent years, the WHO has increased its interactions with the private sector. At the same time it has greatly strengthened its guidelines to prevent conflicts of interest and to increase the transparency of our consultations with external parties. The WHO/FAO report on nutrition arose out of our Global Strategy on Diet, Physical Activity and Health, which our member states mandated us to develop in May last year for presentation to the World Health Assembly in May 2004. The resolution specifically asked us to consult closely with member states and other UN agencies, and to collaborate with civil society and the private sector. In particular, the Global Strategy has implications for those involved at all levels in the food chain. In developing it, we are addressing complex issues that have major implications for governments, health professionals, the food industry, consumer groups, and ultimately for global health.
Through all this, we are involved in a positive, constructive and continuing dialogue with the private sector. However, we will continue to uphold our mandate, and act in the best interests of global public health – even if faced with outside pressure.