Public health prevention should be at the center of global health action

A diabetic patient who is recovering from Covid-19 is being tended to in the municipality of Juchitán in the state of Oaxaca (Mexico). EFE / Luis Villalobos

The COVID-19 pandemic has unapologetically created new fault lines and accentuated old ones in our society, revealing weaknesses in health care systems. It highlights the critical need for governments to prioritize public health prevention to reduce the burden of other diseases, such as noncommunicable diseases (NCDs). A focus on NCDs prevention through the adoption of cost-effective regulatory measures will ultimately allow governments to effectively protect the right to health.

NCDs are the leading cause of mortality in the world and the cause of great social and economic costs. According to the World Health Organization (WHO), these diseases kill 41 million people each year. The rise of NCDs is preventable and can be controlled through the adoption and implementation of regulatory interventions that have had success in reducing the use and consumption of tobacco, alcohol, processed or ultra-processed foods, and sugary beverages. From regulating labelling and packaging, to fiscal measures on certain products, to the regulation of advertising, promotion, and sponsorship of unhealthy products, governments have had a range of measures available to tackle the rise of NCDs associated with modifiable risk factors.

In particular, the international community has increasingly expressed concerns about diet-related NCDs risk factors, such as unhealthy diets, obesity and being overweight, due to their profound impact on the public’s health in many countries. Consumption of processed and ultra-processed, energy-dense, and nutrient-poor food products that contain excessive levels of critical nutrients, such as sugars, sodium, total fats, trans-fats and saturated fats, is known to pose a greater risk for obesity and NCDs. Increased consumption of these products in recent decades is connected to their wide availability, affordability, convenience and palatability, along with commercial promotional strategies.

Back in 2014, then UN Special Rapporteur on the right to health, Anand Grover released a report urging States to regulate food companies’ practices related to advertising, marketing and promotion of unhealthy food products. Since then, national governments and UN agencies have repeatedly emphasized the need to regulate the food and beverage industry to promote healthier lives. Last month, before the end of his six years mandate, then UN Special Rapporteur on the right to health, Dr. Dainius Püras, released a strong statement on the adoption of front-of-package warning labeling to tackle NCDs. In the statement, Dr. Püras noted that “NCDs are a major challenge of this century” and called on States not to remain passive in the face of NCDs and adopt measures to prevent harm to people’s health.

In order to combat the growing burden of NCDs effectively, and to equitably realize the highest attainable standard of mental and physical health across populations, all people must be enabled to adopt healthy lifestyles by addressing preventable risk factors that lead to premature morbidity and mortality. Human rights are essential to respond to the rise of diet-related NCDs, not only because a human rights-based response has proven to be more effective in achieving better public health results, but also because international human rights law imposes obligations on States requiring them to respond to the NCDs epidemic to protect the right to health and health-related rights.

All people must be enabled to adopt healthy lifestyles by addressing preventable risk factors that lead to premature morbidity and mortality.

To that end, Dr. Püras recognizes that “States are required to adopt regulatory measures aimed at tackling NCDs, such as front-of-package warning labeling,” characterizing it as a concrete obligation of States under the right to health. He makes the case by stressing that the “warning” component of this labeling system “allows consumers to identify more clearly and effectively products with a nutritional profile detrimental to health” and “balances the starting point for all consumers by providing equality in access to information relevant to health.” Dr. Püras also explains that front-of-package warning labeling “reduces the perception of healthfulness of food products that contain excessive levels of critical nutrients, such as sugars, sodium, total fats, trans-fats and saturated fats among consumers” and thereby “promotes healthy decisions, discourages the consumption of [these] food products…, and counteracts the effects of living in an obesogenic environment”.

The UN Special Rapporteur’s statement recognizes States’ efforts to adopt NCDs regulatory measures in recent years. However, Dr. Püras expressed grave concern about the multiple tactics deployed by this industry to interfere and influence the adoption of public health laws, regulations, and policies, including misinformation, litigation or threat thereof, and other strategies “to delay and/or block implementation of these regulatory measures, to overturn them or diminish their effect”. Additionally, Dr. Püras observed that the food and beverage industry sponsors research to cover up the harmful effects of its food products, undermining the international human rights law standard according to which rational and rigorous policy-making must be based on evidence that is free from conflicts of interest. As a result, industry-funded research should be scrutinized as an intentional effort to cover up a product’s harm, and government decision-making should instead be “driven by human rights and scientific evidence free from conflicts of interest”.

Without clear efforts to promote action on the prevention of unhealthy diets, the rise of NCDs will remain on the margins of global health action. [States] should adopt an integral approach to reduce the consumption of unhealthy food products through the use of a broader set of laws and regulations”, noted Dr. Püras. The COVID-19 pandemic has emphasized a missed opportunity for governments to devote more resources towards regulating modifiable risk factors for NCDs, such as unhealthy diets. In a post-pandemic world, governments’ priorities must adapt to focus on NCDs prevention, which will alleviate the burden on health care systems, ultimately strengthening their capacity to deal with other diseases, such as COVID-19. It is time for NCDs prevention to be at the center of global health action.