Public health nutrition is a noble cause but its practitioners are increasingly seeing their role in terms of the left-right political divide. But in doing so have they made public health nutrition a target?
Nobody seems to disagree with the idea that improving the nutritional quality of the national diet is a good idea but getting agreement on the best way of achieving it is another thing.
In the 1980s the approach to public health nutrition was characterised by ‘intersectoral collaboration’ – fostering links and cooperation between the agriculture, food processing, nutrition research and nutrition education sectors. The Heart Foundation’s Tick program was born in this era and was based around an acknowledgement of competing interests – the health experts wanted changes to the food supply; the food industry wanted a marketing advantage for the reformulation being requested; and a means of food approval was devised to consolidate the compromise.
Now it’s war!
Fast forward to 2014 and the environment is very different – the notion of collaboration is gone. Now, it’s war! Listen to the rallying cry from none other than Margaret Chan, Director-General of the World Health Organization, at a health promotion conference in Finland last year:
It’s not just Big Tobacco any more. Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation … This is formidable opposition … [There] is a failure of political will to take on big business … When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely. This, too, is well documented, and dangerous.
Chan is channelling contemporary themes in public health nutrition – allocate blame to the food industry, regulate it and strip it of its power. Improved health will follow.
Professor Gerard Hastings from the Public Health Research Consortium in the United Kingdom goes further into the political foundations of industry and indeed society:
… this but scratches the surface of the public health harm being inflicted by consumer capitalism. [Non-communicable diseases] … are only the symptoms of a deep-rooted disease process which puts the pursuit of profit through consumption at the heart of our economic system … Marketing … is actually a powerful combination of philosophy and practice … [that] … has enabled corporations to outgrow countries and manipulate sovereign governments … This is harming not just our bodies through [non-communicable diseases] but our psyches, communities, democratic institutions and ultimately our planet.
This is heady stuff – it makes you want to pick up your sickle and head for the barricades! And we are hearing our fair share of it in Australia too.
Figure: source
But is a confrontational approach what public health nutrition in this country needs at the present time? Conceiving public health nutrition as part of a war against capitalism effectively positions it as an expression of left wing politics. How will this be perceived by the recently elected conservative government in Canberra? This government may welcome health advocacy, but not activism by the Left.
Capitalist dogs fight back
The exaggerated rhetoric of public health nutrition is already attracting increased scrutiny and commentary from the political Right. The typical response from the Right to initiatives to further regulate the food supply is to invoke the ‘nanny state’ wherein interfering, overprotective governments treat their citizens like children. This is in evidence in an article by Nick Cater in the right-leaning newspaper The Australian (18 February) whose response to the World Health Organization’s call to arms against Big Food and Big Soda was:
The nanny state has been recast as the nanny planet and the WHO has assumed responsibility for our diet … ordinary people are held to be no more responsible for what they put in their mouths than curious toddlers who swallow brightly coloured beads … the illiberal tone of public health rhetoric and its contempt for the wisdom of common people should make us cautious.
Cater is alerting like-minded folk in government that public health nutrition is the Left at work and therefore should be resisted.
Figure: source
Cool heads needed
Comrade, put the sickle down – this is a time for cool heads in public health nutrition. Given that the government was elected on a platform of less regulation of business, one has to ask if now is the time for a group of avowed left-wingers to be rattling the gates in Canberra demanding more regulation of the food supply. More importantly, with the razor gang in Canberra looking for targets in the lead up to a tough budget in May it’s probably not a good idea to stand up and yell ‘me, me!’ The current strategy makes Don Quixote look circumspect.
I fear there is a train wreck looming for public health funding. Once the dust settles there will no doubt be lots of finger-pointing at Big Food, Big Soda, vested interests and the dark forces of capitalism, but the reality is that public health nutrition made itself a target. It will be the architect of its own evisceration.
In time maybe public health nutritionists may have to think about collaborating with people again and find leaders who can do the job.
Perhaps the reason for this current approach by public health nutritionist is a reaction to the brick wall they keep hitting in their attempts to work with big industry. I am sure there will be some companies with an ethical attitude towards their profit margins but the efforts of many big companies to make a contribution to the improved health of the public seem to a token gesture, eg McDonald’s salads – dull, expensive and no competition to the smell of hot fries and burgers.
It would be helpful to know any suggestions you have for more effective strategies to influence big companies who only consider what is good for their customers as an after thought to their profits – ie not the ethical ones.
We have seen the effect of the politicization of public health nutrition in QLD with the abolition of all PHN jobs across the state in 2013 by the liberal government. I don’t think it was due to their demands for greater regulation of the food industry, but perhaps it was in opposition to the idea of a “Nanny State”.
I am at a complete loss though to work out how all population groups can be expected to make healthy choices in the face of extreme pleasure, cool good looks, the convenience and great savings on offer by food companies. A complete loss
Help me see it from another point of view?
Hi Jayne. You need a strategic plan!
Firstly, be optimistic. There are enough dreary pessimists around. There are better times ahead.
Dot point number 2: Public health nutrition is not a sprint; it’s a long distance race. You need to be fit and to persevere. But if you apply the right pressure in the right place for long enough sooner or later you make some progress. So rejoice. Don’t bag Macca’s out because they still sell burgers; congratulate them for taking a step in the right direction with their salads and ask: what’s next?
Dot point number 3: It’s very easy to criticise the food industry but you should also try to understand it. There is one huge constraint that industry faces – their customers! There are scores of examples of healthier food products that have been developed and then modified after the crucial step – consumer testing. If groups of people taste a new product and all say ‘needs salt’ what do you think the food company is going to do? They reformulate it. Most new products fail in the marketplace, so no company is going to try to launch a product that fails the taste test during the consumer testing phase. The products made available to the public by food companies are continually negotiated and renegotiated.
There is a big difference between dietitians/nutritionists and food companies: Dietitians tell people what they need to eat; food companies ask people what they want.
Regards
Bill
There will never be a good time to make a noise about food corporations and the effect they have on public health. No Government will like it because it impacts economy and jobs and for their own best interests it is better to play into the idea that economy and jobs are the most important things and that public health can never coexist with either. Getting in to bed with food corporations as a solution to public health is like accepting funding from mining companies to improve community life. Both situations are based on public relations and give little regard to the actual issue beyond what they can claim to have contributed. There is too much to be done outside if the processed food industry to even consider starting a conversation with them. Why we bother, I have no idea.
Hi Jenna
Are you familiar with the Monty Python movie ‘Life of Brian’, set in Biblical times? In one scene a group of locals is whinging about the occupying Romans and their leader sneers ‘What have the Romans ever done for us?’
After a short silence one of the group answers ‘the aqueduct’ and then another pipes up and says ‘sanitation’. Others chip in with ‘the roads, irrigation, education, public baths, wine, public order’ and so it goes on.
Perhaps we should all ask ‘What has the food industry ever done for us?’
Well, I guess they did help eradicate nutrient deficiency diseases – I guess we should give them that one. And they did create abundance when previously there was scarcity. And they did drive prices down such that even the poorer sections of society can now afford to feed themselves and their children. And when the World Health Organization asked the food industry to come up with new spreads rich in polyunsaturated fats to replace butter they did oblige. And when people said we want lower salt spreads they provided them too. And when people demanded convenience the food industry provided that too. And when we worked out that trans fats weren’t good for us the industry did largely remove them from our food supply well before anyone even thought about regulating it.
But I ask you, what has the food industry ever done for us?
Regards
Bill
Indeed, the food industry provides us with food – congratulations to them!! They drive down prices of various combinations of wheat+salt+other-cheap-additives so that ‘the poor’ can afford food. Fabulous, there is value in this but imagine if they could effect the provision of food of high-nutrient-density so that it didn’t make people sick at the same time. Low-salt spreads -ffft! I would be extremely suprised if they did this without altering their advertising to make up for sales elsewhere, while advertising how great they were at the same time.
This is exactly my point Bill. Your sarcasm around ‘what has the food industry ever done for us’ is a perfect example of how food corporations constantly try to prove that they are having a net benefit for nutritional health. I agree with you – they provide us with food and nutrition and make sure people have at least the calories and the protein to survive. But in the world today and with the budgets they have, that quality alone is absolutely pathetic. PATHETIC. But yet our profession pretends that it is acceptable, and even worse, admirable!! We are groomed to encourage the production of processed foods, let’s not kid ourselves. If the dietetics industry can’t even see marketing for what it is, what chance does the rest of the world have?
Bill,
Support of public health nutrition shouldn’t be framed as either left-leaning or right-leaning. Lack of attention to public health by governments is short-sighted, in a similar way that lack of attention to maintaining health is for individuals.
It’s a complicated world – not all of the activities we allow or encourage as a society are consistent with good health. It’s actually great to have people speak out about the perceived source of problems and suggest solutions -its part of a working democracy regardless of which political party holds government. The suggestion that public health nutritionists should keep quiet for a while and hope that no-one notices them does an injustice to passionate practitioners and their supporters.
As you know, companies and industries often see the writing on the wall and take action prior to being made to do so. Someone needs to be writing on the wall, and many players contribute to this. I’m grateful that public health nutritionists are among them.
Public health practitioners have never stopped collaborating, and PHNs are not an exception to this. Collaboration is undoubtable powerful when win-win solutions can be implemented, and the first principle should be to find common ground. The Tick program has sustained this over decades. However, win-win isn’t always possible at a point in time, and a rational response is to move on.
You’d agree with most of this, right?
Hi Malcolm.
I certainly agree with your comment that support of public health nutrition shouldn’t be framed as either left-leaning or right-leaning. That was the point of my post. It would be good if public health, and public health nutrition in particular, survived political cycles largely intact but this is not our experience. We’ll have to see if history repeats itself yet again when the budget comes down in May. I don’t think it’s looking good.
For public health practitioners, there are times to play the consensus game and times to play the activist game. But timing is everything. Right now I’d encourage public health practitioners to be cautious. But then again at a forum in Sydney yesterday one of the speakers alleged that the body representing the food industry was the greatest threat to public health in Australia …… (sigh).
Regards, Bill