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A policy for public health

While it is urgent to look at the marketing of unhealthy products and put in place regulations, it will be more productive to address NCDs under a wider policy net of binding laws and regulations

A policy for public health

Whenever I visit a shopping mall with my family and visit a food court to grab a quick bite before going home, I am always amazed with the food that is on offer. The food courts these days offer a variety of food but the ones which catch our eyes are the fast food outlets with teenagers and young adults, even mothers with infants in prams flocking these.

Once you are in the food court, it is impossible to miss these outlets with their well thought out advertising, catchy phrases and a choice of logos and colours which probably have gone through immaculate research before being finalised.

Looking at the advertising of these fast food outlets gives me a strong sense of déjà vu of the times when advertising for cigarettes was rampant, visible to the young, adults, and elderly, and followed the same pattern of colours and designs that catch your attention and imagination.

One may think that with all the advancements in public health, things have moved on but unfortunately they haven’t. This is true not only for Pakistan but also for other countries facing a transition of economies. With more money to spend, the consumers in these countries provide the multinationals an open playground to expand their businesses. The commercial industry in turn uses information technology to expand its consumer base and enhance profits and to exploit any loophole in the laws or policies in place in that country.

While it is difficult to find middle ground, one thing is certain that we as public health community should not in any way accept voluntary codes adopted by these industries. Regulating the advertising and promotion of these products should form a part of wide ranging policies at the national level.

We may think that tobacco advertising, promotion and sponsorships (TAPS) are things of the past but having observed tobacco industry’s behaviour for the last 20 years, I feel disconcerted with what is happening now. The big billboards or mass media advertising campaigns may have disappeared but other channels continue to be used. The globe at the end of Constitution Avenue in Islamabad is a stark reminder of tobacco industry’s presence in the corridors of power.

And as if this is not challenging enough, the industries learn from each other’s experiences not only on what marketing strategies work but also how to avoid regulations curbing effective legislation efforts. It’s not surprising that their marketing techniques resemble each other as if they are singing from the same hymn sheet. For example members of their boards share portfolios and sit on board of directors of the other industries associated with the Noncommunicable Disease (NCD) risk factors.

The resemblance, therefore, is not only the outward images we see but also the strategies they use to block or at least delay effective public health policy development and adoption. While the industries learn from each other and follow the same techniques, public health professionals need to assess if we are doing the same and lessons learnt from observing tobacco industry’s behaviour are being utilised to a maximum.

Noncommunicable Diseases (NCDs) are now the leading causes of death throughout the world. These diseases — namely cardiovascular diseases, cancers, chronic lung diseases and diabetes — cause roughly 65 per cent of global deaths. The burden from these diseases is set to increase as the global population ages. Over 85 per cent of NCD deaths take place in low- and middle-income countries (LMICs), furthering financial hardship and threatening poverty reduction programmes including national development.

Behind the morbidity and mortality caused by NCDs are the four modifiable risk factors — tobacco, alcohol, fatty foods and salt backed by their respective industries. (We may think that alcohol is banned in Pakistan but anecdotal evidence does suggest its use in some sections of our society).

These industries like the tobacco industry in the 1980s want to avoid regulations on their advertising and promotion and have, therefore, adopted a set of voluntary codes or have worked with governments to put in place policies which are partial and with limited focus. These voluntary codes or policies are mainly aimed at preventing only the children’s exposure to advertising of their products.

One thing tobacco control has taught us is that ‘Voluntary Codes’ or partial restrictions do not work. For example, even after the passage and coming into force of World Health Organisation — Frame work Convention on Tobacco Control (WHO-FCTC), young adults and children are still exposed to tobacco advertising.

According to World Health Organisation’s (WHO) Global Tobacco Control Report (GTCR) 2014, only 12 per cent of the world population is protected by comprehensive Tobacco Advertising Promotion and Sponsorship (TAPS) policies.

Another fact which compounds the situation is the fact that it is the low and middle income countries that are faced with a growing burden of NCDs. With growing economies and better purchasing powers, populations are now — led by the advertising campaigns of the industries — switching from healthy foods to so called fast foods. Monitoring of ‘voluntary codes’ or ‘partial restrictions’, in these under resourced countries is and will remain a challenge.

So where do we go from here? Do we, as public health professionals, while working on comprehensive bans on TAPS, also advocate for a comprehensive ban of sugary drinks and high salt and fatty foods’ advertising and promotion campaigns including sponsorship of events or do we accept ‘voluntary codes’ or partial restrictions.

While it is difficult to find middle ground, one thing is certain that we as public health community should not in any way accept voluntary codes adopted by these industries. Regulating the advertising and promotion of these products should form a part of wide ranging policies at the national level. These policies are needed to address the unregulated marketing of unhealthy products along with strategies to fulfil the commitments countries have made in the shape of Sustainable Development Goals (Goal 3 – Health) and to successfully reach the targets under the declaration of the UN High Level Meeting on NCDs 2011.

WHO’s Global Action Plan for prevention and control of NCDs 2013-2020 outlines a set of policy options to address these concerns. These policy recommendations need to be translated into national policies and strategies starting with strengthening of health infra-structure to tackle NCDs and building the capacity of the relevant stakeholders to lead and coordinate NCD efforts. This should be supported with a coordinated effort involving UN bodies and International non-governmental organisations.

A piece meal approach to NCDs will not work. While it is urgent to look at the marketing of unhealthy products and put in place regulations to curb these, it will be more productive to address NCDs under a wider policy net of binding laws and regulations. A comprehensive national policy on NCDs prevention should act as a platform to address risk factors for major NCDs, and to provide coherence with other health, fiscal, environmental and social policies.

A delegation from Pakistan will be attending WHO Global Conference on NCDs ‘Pursuing policy coherence to achieve SDG target 3.4 on NCDs’ in Montevideo, Uruguay, October 18-20, 2017. It is vital that a national consultation is undertaken to develop a set of recommendations for this conference and to present these at this meeting as a road map to achieve SDG targets.

Ehsan Latif

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