World Antibiotics Awareness Week: Global food brands must take Antibiotics off the Menu

Anna Glayzer, Advocacy Manager at Consumers International, outlines the need for an urgent, global response to the world's escalating antibiotic resistance crisis. 

This week is World Antibiotics Awareness Week. Given the seriousness of the public health crisis we are facing, there are few topics more in need of heightened worldwide awareness than antibiotic resistance. Many people do not realise that we are a few decades away from the end of modern medicine as we know it. By 2050 drug resistant infections will cause 10 million deaths- becoming a bigger killer than cancer is today.

Resistance to antibiotics occurs naturally with use, making it essential that we use these drugs sparingly, for the treatment of disease, where prevention and other methods of treatment have failed. Instead, the irresponsible use of antibiotics is a major driver of resistance.  Farm animals consume two thirds of the world’s antibiotics. These vital drugs are often routinely added to feed to make animals grow faster or to counter unsanitary conditions in factory farming facilities.

This week is also the one year anniversary of the publication of research showing that the threat from Colistin resistance was far greater than previously realised. Colistin is one of the antibiotics on the World Health Organization’s critically important list. It is used in human medicine as a drug of last resort- something to be prescribed when other antibiotics have failed. Colistin resistant infections in food animals and humans are spreading around the world.This is being driven by agricultural use of Colistin, which continues to rise year on year.

Our campaign #AntibioticsOffTheMenu is about calling on global food businesses to end the routine use of all antibiotics included on the World Health Organization’s list of critically important antibiotics. This week we have published an open letter to the CEOs of KFC, Subway and McDonald’s calling on them to make global commitments to end the routine use of all antibiotics included on the World Health Organization’s list of medically important antimicrobials, in all of their livestock supply chains. This means prohibiting suppliers from using these antibiotics for growth promotion or disease prevention and only using these antibiotics when there has been a diagnosis of illness.

Global food brands like KFC, Subway and McDonald’s are in a position to make an impact on the antibiotic resistance crisis, faster than legislation alone. Subway and McDonald’s have already made commitments in North America. In the USA Subway has committed to only source meat and poultry raised on no antibiotics. McDonald’s USA already serves chicken in the raised without the routine use of any of the antibiotics from the WHO list, with McDonald’s Canada soon to follow.

We welcome the progress by Subway and McDonald’s in North America but action in one country or one region is simply not enough. Antibiotic resistance does not respect national boundaries.  Our food and farming systems are more globalised now than ever. Resistant bacteria spread from the guts of farm animals via faeces, air, soil, water, contact with farm workers, contaminated meat.

The response to the antibiotic resistance crisis the world is now facing will need to be multifaceted. Prudent use in human medicine, better hygiene in health care and the development of new drugs will be needed.  We cannot escape public health disaster unless we tackle agricultural use of antibiotics.

The World Health Organization, the UN, the G20, governments, scientists, consumer and environmental advocates, academics and medical professionals all over the world are calling for urgent action to stop the threat of antibiotic resistance.  Global, consumer facing food brands should act now, and act globally.

Taking global action to end childhood obesity

Hannah Brinsden, Head of Advocacy & Public Affairs at the World Obesity Federation, discusses childhood obesity ahead of World Obesity Day 2016

This year World Obesity Day, which takes place on 11^th October, is focusing on childhood obesity. The message is simple:  Governments need to up their game and urgently take leadership and comprehensive action to end childhood obesity.

In the last decade, childhood overweight and obesity has risen significantly around the world. Figures from 2013 show that approximately 222 million school-aged children globally are overweight or obese and our latest estimates suggest that this number is set to rise by about 20% by 2025. The impact of this is not to be underestimated. Not only does it put our children’s future health at risk but it impairs their immediate health, increasing their risk of type 2 diabetes, raised blood pressure and non-alcoholic fatty liver disease. This puts our already struggling health systems under more strain. This is preventable and the need for action is unquestionable, but what will it take for the required action to be taken?

Obesity is a chronic form of malnutrition and in many low- and middle-income countries it is often found alongside undernutrition. This means that nutrition policies that promote healthy growth, ensure household nutrition security and protect children from marketing and advertising of foods which have low nutritional quality will be an essential part of our efforts to end childhood obesity.

Arguably we’ve come a long way in nutrition policy over the last few decades. More and more countries are starting to implement marketing restrictions, school meal guidelines, interpretative nutrition labelling and sugar taxes. But it’s not nearly enough. While best practices can be found, very few countries have implemented the full package of multi-sectoral policies. This is despite extensive research and repeated recommendations for action in this area, most recently in the report of the WHO’s Commission on Ending Childhood Obesity. 

So why the resistance? Some of this will be due to a lack of capacity, in other cases a result of the prioritisation of other issues. But in most cases it comes down to an issue of political will. Not so much a lack of political will to protect the health of our children, I think you’d be hard pushed to find someone who would admit to that (!), but a lack of political will to challenge the commercial drivers of our unhealthy food environments. This leaves governments exposed to weak and voluntary policies and a leniency in favour of private interests rather than the public good. As a result, childhood obesity, and indeed adult obesity, continues to rise.

If we are to improve the global state of nutrition, strengthen national food sovereignty and reduce childhood obesity we need to consider something different and more far-reaching. If we are to have hope of change, we need to explore legally-binding frameworks to protect and support governments, particularly in regional economic areas and smaller nations. Having a legally binding mechanism would help to define minimum nutritional standards to drive commercial food markets and the operation of global food trade. Further, it would help governments to enact the policies required to end childhood obesity and would help to protect governments and citizens from commercial interests and food markets which often undermine efforts to protect health.  

So this World Obesity Day, we are calling on governments around the world to fulfil their commitments made earlier this year and to take urgent action to end childhood obesity. We must also explore the mechanisms that will be required to effectively implement such a comprehensive package of policies. A legally binding framework to protect diets isn’t about hindering governments, it’s about supporting them in taking the required steps, as difficult as they may appear, to protect the health of citizens all around the world, and to ensure a healthier future for all. 

For more information about World Obesity Day visit www.obesityday.worldobesity.org

For more information about Consumer International and World Obesity Federation’s calls for a framework to protect and promote healthy diets see here. 

New mercury convention adopted by 94 governments

Michael T. Bender, Co-Coordinator of the Zero Mercury Working Group, a global coalition of over 90 public interest non-governmental organisations, blogs on the dangers of mercury, outlining what is being done to reduce its use and exposure.

A new global legally binding agreement, the Minamata Convention on Mercury, was signed by 94 countries last October in Japan after more than a decade of study and debate.

In January 2014, the World Health Organization’s Executive Board adopted a resolution in support of the new Convention.

During that meeting and on behalf of Consumers International, I presented a supporting statement.

However, the resolution won’t be finalised until it’s adopted by the World Assembly in May.

Mercury presents a health hazard because of its global dissemination, persistence, toxicity, and bioaccumulative nature.

Exposure is ubiquitous and can occur through a variety of pathways, but most prominently through ingestion of contaminated fish and inhalation of mercury vapours from artisanal and small scale gold mining (ASGM).

The evidence now available suggests that methylmercury has adverse effects at doses below those declared acceptable 10 to 15 years ago.  Yet it may take several years until exposure guidelines can be updated to reflect the changing body of epidemiological evidence.

Therefore, an extra degree of caution about prenatal methylmercury exposure seems warranted, and adds urgency to the Convention’s objective of reducing emissions.

The Convention’s objective is to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds.

Over time, the Convention bans primary mining for mercury, curtails trade, phases out mercury uses in products and processes, and regulates releases from coal-fired power plants and metals production facilities.

The Convention is designed to be pragmatic and flexible, and attempts to strike a balance with control measures tailored to particular issues, some legally binding and others voluntary.

It recognises issues such as ASGM cannot be solved by regulations alone, but require broader attention within a sustainable development context, allowing time for societal and industry transformation.

However, the treaty has been rendered less effective by long delays before important mercury reduction mandates for larger sources enter into force.

To the extent politically and technologically feasible, reducing human exposure to mercury through the Convention and related activities is projected to save billions of dollars of avoided human exposure costs worldwide for generations to come.

A recent study estimates that up to €9 billion per year in avoided damages could be saved in Europe alone by reducing the exposure risk from methlymercury to children's brains.

Now that the Convention has been adopted, all governments should be urged to quickly ratify the Convention and enact policies to reduce mercury use, trade and pollution and exposure to mercury. Once 50 countries ratify the Convention, it enters into force. 

While there are alternatives to most mercury products and processes, and cost-effective technologies available for controlling most major sources, there are no alternatives to global cooperation to reduce human exposure to mercury. 

Michael T. Bender is Co-Coordinator of the Zero Mercury Working Group, a global coalition of over 90 public interest nongovernmental organisations from more than 50 countries, see:  http://www.zeromercury.org/. Parts of this blog appeared in an article by Michael Bender, Ned Groth and Elena Lymberidi, published in the Journal of Public Health Policy in October 2013.

For more information on the new Convention, visit: http://www.mercuryconvention.org/.

The risks associated with Big Food funding

Boyd Swinburn, Professor of Population Nutrition and Global Health at the University of Auckland , blogs on the issue of funding and food.

At the recent International Congress on Nutrition, the big global gathering of nutrition scientists every four years, I was invited to give a presentation, but when I tried to get the Congress to send out a press release on my message criticising Big Food, the organisers declined to do so. Big Food were major sponsors of the Congress.

I recently had a rather challenging and delicate time trying to get a joint press release out in the name of the recent International Congress of Nutrition - a big global gathering of nutrition scientists that occurs every four years.

It appears the big corporate sponsors of the event did not take kindly to my belief that Big Food undermines healthy food policies.

I do understand where these conference organisers are coming from: I have been the president and council member of several professional and scientific organisations and we were always faced with this dilemma of wanting to put on a good, affordable conference with top speakers without having to rely on sponsors that blow our organisation’s credibility.

As I did not succeed in getting permission to have a press meeting (or issue a press release in the name of the conference), I am trying other means to get the messages out. My writing is usually by way of logical, scientific papers (in fact, I think this might be my first official blog), so bear with me while I give you the background to this.

Over the last several years, it has become increasingly apparent that Big Food is he major barrier to getting governments to act on things like soda taxes or getting consumer-friendly front of pack labels. These multinational corporate giants will come down on policy makers like a ton of bricks if they even attempt such regulations.

As an example, Norway, which has been the global champion for regulating junk food marketing to children, is struggling heavily against industry pressure in even getting its own regulations enacted.

Several Latin American countries have seen a burst of government attempts to get healthy food policies to help combat their growing obesity problems and each time they have been battered to the ground by industry pressure (with the recent success of the Mexican junk food and soda tax an honourable exception).

The usually conservative World Health Organisation, has become very outspoken with the Director General, Dr Chan, lumping Big Food and Big Soda into the same basket as Big Tobacco and Big Alcohol who wrote the text book on how push governments around.

At the obesity conference Bellagio, Italy a few months ago, several developing countries presented papers about their country’s progress on addressing obesity. Whenever governments attempted to enact healthy food policies, Big Food rose up to squash them down.

We heard the story so many times that the group decided to make a declaration on Big Food’s influence on undermining healthy food policies and called on governments, WHO, international agencies, researchers, foundations and civil society to undertake specific actions to address this.

This increasing trend of big business dominating public policy development really worries me as a health professional and a citizen. Although I am supposed to be a dispassionate researcher, I can’t help getting very heated about this corporate hubris and erosion of democratic processes.

If your temperature is also going up as you read this, check out the Bellagio Declaration which suggests actions that governments, civil society, academia and funders can take to counter the undermining influence of Big Food on healthy food policies

Lifestyle diseases will be responsible for almost three-quarters of deaths by 2020

CI’s Justin Macmullan explains why NCDs are a consumer issue and what CI is doing to help improve the path to health.

One of the greatest health challenges facing the world today is how to reduce the incidence of diseases such as cancer, heart disease and diabetes.

The World Health Organisation (WHO) estimates that worldwide, these diseases (known as noncommunicable diseases (NCD)) currently represent 43% of the burden of disease and are expected to be responsible for 73% of all deaths by 2020.

Most of this increase will be accounted for by emerging NCD epidemics in developing countries.

The prevalence of these diseases is closely linked to four risk factors; unhealthy diets, a lack of exercise, smoking and excessive alcohol consumption.

This means the challenge of reducing these diseases is very much a consumer issue - how to help consumers to live healthier lives.

Healthier diets

Last week I joined a group of academics and civil society groups from around the world for the inaugural meeting of the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS).

INFORMAS seeks to address what some believe to be the most pressing of these challenges – unhealthy diets – by monitoring the ‘food environments’ that influence our dietary choices.

Food environments are made up of all the different factors that influence the availability, affordability and acceptability of food, and together, this group aims to develop rigorous international tools to monitor these developments.

Issues under discussion include the sort of food that is available to consumers, the cost of that food, the information that is available about that food and the marketing of food to children. Crucially, INFORMAS will also look at the public and private policies that affect these different factors.

It’s an ambitious programme but, from CI’s perspective, these tools will not only be important for the development of our members’ own tests and surveys but the results will provide invaluable evidence for our advocacy on food and nutrition.

UN targets

This work will also take on added significance in the light of recent UN commitments to monitor countries’ progress in tackling NCDs.

Most of the benchmarks for monitoring which are being developed by the WHO are likely to track the incidence of the diseases and the risk factors, but, of course it will be international, regional and national policies that will drive progress.

Improving diets is no small challenge. Many countries have already followed a path that leads to more processed food and higher levels of fat, sugar and salt in the diet, but with the evidence generated by the INFORMAS tools, and our members’ on the ground experience, CI will be well placed to argue for policies that will reverse the growing number of people suffering from these diseases.

Nutrition conference: no unhealthy foods, just unhealthy consumers. Hubert Linders, CI Information Adviser, finds this hard to swallow.

Last week I participated in the most important conference for nutritionists in Latin America to officially launch the PAHO policy statement on reducing salt intake. About 2000 professionals and students were in Santiago to learn about diets, micronutrients, functional foods, food safety, or malnutrition, which not only means that there are people sick or dying because they don't have enough to eat. Increasingly it is used for overweight and obese people who eat too much processed food with high levels of salt, sugar and fat.

According to the industry, there are no good or bad foods, only unhealthy diets and a sedentary life. If that's true, why is fast food offered in huge portions? Or are fruit juices produced with flavours that don’t come close to the taste of the fruit shown on the packaging?

Asking companies, present with samples of their products, they told me ‘this is what the consumer wants.’ I very much doubt that. Does the industry produce what consumers want or do we eat what they offer because there are almost no other options? True, there are products called ‘light’, with less salt and better quality, but why do they always have to be more expensive?

If the industry produces what we want, why spend billions of dollars a year in advertising? On several occasions during the congress I heard that nutritionists have to educate consumers, called ‘patients’, because they don't know the truth. It seems obvious that they do not, simply by the fact that food ‘rich’ in salt, sugars and fats are more and more aggressively marketed in all media including TV, radio, Internet and on billboards, kiosks, schools and sporting or cultural events.

All this marketing is paid for by an industry that would have us believe that it is only our fault that almost all of us suffer from overweight and diseases like hypertension, while they want to ‘hook’ us on salty, sugary and greasy foods as young as possible. That leaves a bad taste in my mouth.

Fighting chronic non-communicable diseases

The Pan American Health Organization (PAHO) recently organised a workshop to think about setting up a multi-stakeholder forum to fight chronic non-communicable diseases. CI's Hubert Linders, Information Consultant and Project Coordinator, attended the meeting and writes from Santiago:

'On 23-24 March 2009, the Pan American Health Organization (PAHO) organised a workshop to think about how to set up a multi-stakeholder forum where governments, civil society organisations and industry should come together to fight chronic non-communicable diseases (CNDCs). Among governments and civil organisations, Consumers International was also invited.

These diseases, like diabetes type 2, hypertension, obesity, cardiovascular diseases, some types of cancer and osteoporosis, are the main causes of premature deaths, 80% of which occur in low and middle income countries. Physical inactivity, an unhealthy diet with too much sugar, salt and fat, smoking and abuse of alcohol are the main causes of CNDCs, affecting more and more the poor people.

And what is worse, these diseases can be prevented in many cases. Lowering the salt consumption with 2 to 5 grams each day and smoking less can prevent globally 13,8 million deaths in the coming 10 years[1]! With some other measures, like extra physical activities, etc. this number can be still higher.

Now to be able to achieve that, large changes are necessary which no one party, be it government, industry or civil society, can accomplish by itself. So there is a strong need to bring these parties together to fight the epidemic of CNDCs. What we, governments and NGOs, tried to envision in the two days of brainstorming and work lunches was how to involve the industry without generating conflicts of interest.

Listening to previous experiences of creating alliances and projects, one can see that there are many things going on but these are not aligned. They work locally or nationally or treat specific diseases. The new forum that PAHO is setting up should comprise all CNDCs and all countries in South and North America. A huge task but this is where the transnational companies, selling their sometimes not so healthy food in almost all the North and South American countries, come in.

There is mistrust between NGOs and large corporations. What happens if a company, willing to sponsor a PAHO project, earns money selling unhealthy products (alcohol, tobacco, unhealthy foods and drinks)? Well, the companies related to alcohol or tobacco or guns will never be allowed to do so. Industry with product or services damaging (public) health cannot either. Moreover, companies with a bad corporate social responsibility record are also not considered. PAHO has very strict rules to scrutinise companies and deciding whether they can form part of the platform. Its reputation is at stake and cannot be compromised.

On the other hand, we know that industry is very interested in participating. Maybe because this way they hope to get recognition for their self regulation programs. The food industry got together to start removing trans fats from food stuff. Something which could serve as an example for lowering levels of salt, even though from experience, we know that self regulation alone is not sufficient.

It is interesting and dramatic at the same time to see that many governments are spending their health care money on curing diseases, while they could spend it much more efficiently on preventing people from getting sick in the first place. Doctors are educated in treating patients, not really in preventing people from contracting a disease. The CNDCs will grow in such a pace that the costs involved will explode and be unsustainable soon. Changes have to be made, nationally but also internationally. Even the WHO needs to do so.

Talking about this, we agreed quite quickly and we discussed the next steps that should be taken. And now it is time to stop talking and start doing things. We need to go back to our workplaces, organisations, etc. and figure out how to move forward. In the months to come meetings will be held where industry shall be invited together with other civil organisations. Governments of all countries in the region will be invited too. The plan is to create an alliance with clear roles and criteria for all participating sectors and launch it at the end of 2009. WHO is planning to do so in other regions as well.'

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[1] The Lancet, Volume 370, Issue 9604, Pages 2044 - 2053, 15 December 2007 Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use Perviz Asaria MPH, Dr Dan Chisholm PhD, Colin Mathers PhD, Majid Ezzati PhD, Robert Beaglehole DSc