Healthy Caribbean Coalition

1. Healthy Caribbean Coalition Global NCD epidemic and civil society responses

3. Global causes of death Population 6,000,000,000 Total deaths per year 54,000,000 (0.9%) Cardiovascular death 17,000,000 (31%) 44% coronary heart disease 31% stroke 78% in low income countries AIDS 3,000,000 Tuberculosis 1,000,000 Malaria 1,000,000 (mostly in Africa)

4. Regional differences in cardiovascular disease in 1990 Latin America Middle Eastern Crescent Cerebrovascular disease Sub-Saharan Africa Other Asia Coronary heart disease China India Former socialist economies Established market economies 0 500 1000 1500 Number x 103 from Murray & Lopez The Global Burden of Disease 1996

5. Global trends • Increasing and inexorable increase in the global burden of the avoidable chronic diseases • We are united by common challenges and solutions • Collective solutions • International determinants of health and disease • Previously unintended consequences of development • No excuses now! Public health has grown up – un-natural experiments.

6. Global developments and trends • WHO commission on the social determinants of health (2009) • The causes of the causes and inequalities • Social determinants of health – economic, ,fiscal, market, commercial, environmental, social ,cultural and civic • Lifestyles shaped by determinants • Necessary but not sufficient conditions

7. Global developments and trends • Unsustainable demands on health and social services • Breakdown of the intergenerational contract • Public health is about the influencing the control of the determinants • HIE’s and the spread of chronic diseases to MLIE’s • Absence from the MDG’s

8. Global developments and trends • Tobacco, food and alcohol culture and economy • Consumption industries • Globalisation • Power of the vested industries • The games they play • Health creating culture an economy • Light touch self regulatory world • Regulatory challenges

9. Global developments and trends • CNCD”S have been neglected especially ion low and middle income economies and by development organisations and Governments • Global economic and social polices are driving the chronic disease pandemic • Political failure not a technical failure-low cost effective solutions available • Political opportunities for progress are available

10. Global developments and trends • Political opportunities for progress are available –ECOSOC, UN high level summit • WHO NCD strategy • WHO recommendations on the marketing of foods And non alcoholic beverages to children • WHO salt • FCTC • WHO commission - social determinants

11. Summary: • The evidence matters • Importance of social justice. • Empowerment at the heart • Material – income • Psychosocial – control • Political- having voice • Evidence • Social determinants. • Social gradient. • Action • Improve daily life • Tackle distribution power, • money and resources. • Understand problem

12. Population level determinants of lifestyles • Social • Environmental • Economic • Cultural • Commercial and market • Global/EU • Civic • POLITICAL

13. The Public Health Challenges • Commercial determinants of health • Changes in (over) consumption largely driven by unfettered marketing • Dietary and market transitions – UK phenomena last 25 years. Changing faster elsewhere in the world - accelerated by globalisation and growth in neo liberal market economies • Market and regulatory failures • Public health failures

14. The Public Health Challenges • Challenging the domination of self regulation – a mostly flawed concept • Challenging the soft paternalistic responses which widen health inequalities • Protecting children and young peoples health • No longer unintended consequences – collateral damage • Policy convergence – joining forces e.g. the Lisbon agenda - sustainable equitable economic development

15. Main prevention trends over 1980’s onwards • Integration of chronic disease prevention policy and action –ACD’s • Lifestyle - Primary risk factors • New population level risk factors - obesity • Changing intergenerational risks • Ecological approach – tackling the social, economic and environmental determinants • Inter-sectoral

16. What levers are available and who is the honest broker?

17. Get ahead of the curve and do not repeat mistakes made elsewhere and learn fast via a connected of global civil society community

18. The role of civil society in promoting the publics’ health • Sustainable social change • Trusted • Independent • Non ideological • Advocacy – voice amplified by powerful alliances • Voice of the less well reached • Keeping public health a public good • Population health measures

19. The role of civil society in promoting the publics’ health • Countervailing force for the excesses of industry and unhelpful and unproven ideologies • Champion of the public interest

20. TOBACCO CONTROL

21. The UK food culture and economy

22. FOOD AND PHYSICAL ACTIVITY LINKS

23. THE FUTURE

24. After a two-year tour of the United States, Michelangelo's David is returning to Italy... His tour sponsors were:

25. Why a project on obesity? 1997-99 2000-02 1994-96 Female Data shown for England and Scotland Male Source: IOTF Data source: IOTF

26. Foresight Tackling Obesities: Future Choices

27. Project key messages • Most adults in the UK are already overweight. Modern living insures every generation is heavier than the last – “Passive Obesity”. • By 2050 60% of men and 50% of women could be clinically obese. Without action, obesity related diseases will cost an extra £49.9 Billion per year • The obesity epidemic cannot be prevented by individual action alone and demands a societal approach. • Tackling obesity requires far greater change than anything tried so far, and at multiple levels; personal, family, community and population. • Preventing obesity is a societal challenge, similar to climate change. It requires partnership between government, science, business, and civil society.

28. Humans are endowed with an ANCIENT PHYSIOLOGY moulded by famine ... .... and ill equipped to handle our modern food environment …. … especially when we do so little!

30. Parallel to Climate Change • Complex problem • Challenge for whole of society • There is a danger that the moment to act radically and coherently will be missed • A market failure

31. Synergies with other policy areas

32. Healthy Weight, Healthy Lives

33. Architecture and characteristics • Cross government • Multi-sectoral • Environmental determinants • Population and individual • Whole systems impact • Multiple interventions • Natural experiments • Lifecourse

34. The big Five – the foods that most concern us Snacks Fast foods Confectionery Sweetened cereals Soft drinks Energy-dense and salt rich foods: contribute high proportion of calories to the diet encourage passive over-consumption often displace other healthier foods.

35. The recommended diet vs the advertised diet • Around three-quarters of food advertising to children is for sugary, fatty and salty foods. For every £1 spent by the WHO promoting healthy diets, £500 is spent by the food industry promoting unhealthy foods

38. The processed food culture and economy

40. Cadbury’s – chocolate for sport? 1 netball = 20,000 kcal 1 volleyball = 72,000 kcal 2 net posts = 1,200,000 kcal

41. How popular Pepsi is!

42. Marketing to children

43. Give them your phone number Download their ring-tones

44. Marketing methods candy counting books

45. Equip the team...with McDonalds

46. Nutritional food labelling • Colour coded front-of-pack labels • Quick and easy for all social groups • Enables shoppers to accurately assess and compare products • One universal scheme on all brands in all shops • Pressure / praise for retailers and companies • Frame the arguments for EU regulation?

47. Outcomes • Product reformulation • Nutrient profiling established • Industry wide adoption of front of pack nutrient signpost labelling • Industry behaviour publicly exposed • Opposition to industry’s flawed labelling schemes to force a proper debate at EU level and set the scene for the review of the EU labelling directive

48. GDA report – February 2007