The health of nations

The United Nations has been drawing attention in recent years to the growing burden of non-communicable diseases, which have been adding to morbidity and premature deaths in most countries. In a declaration issued at a high-level meeting in 2011, the U.N. argued that low and middle income countries should actively pursue public health policies that will reduce the incidence of NCDs arising from diabetes, hypertension, high cholesterol, and a high body mass index. One of the countries that is at the epicentre of these health concerns is India, due mainly to weak public health policies and changing lifestyles. As The Lancet points out in recent commentary, much of the burden of non-communicable diseases is linked to the consumption of tobacco, alcohol, and ultra-processed food and drink (which are energy dense but nutrient poor). The public health community now unanimously accepts the link between these and a higher burden of NCDs. Neglect of chronic diseases by India has, according to the World Health Organisation, cost the country $9 billion in 2005 due to premature deaths caused by heart disease, stroke and diabetes. Over a 10-year period, the losses are projected to rise to a colossal aggregate of $237 billion.

While tobacco and alcohol are receiving close scrutiny as key factors influencing disease burdens, including cancer, the role of ultra-processed packaged food is not getting the attention it deserves. The makers of all forms of packaged food see India as a gigantic emerging market — and source of profit growth. Moreover, advanced markets are saturated. It is here that regulation of unhealthy food holds the key. The primary goal should be to use taxation, labelling and awareness creation to make high-energy, low nutrition foods unattractive to the consumer. There is a deplorable trend among food manufacturers to push less harmful packaged food as being actually ‘healthy’. This travesty must be reversed through determined policy intervention, and consumption of wholesome, fresh meals high in vegetable and fruit content must be encouraged. It is relevant to point out here that the biscuit industry has been lobbying in India to displace fresh-cooked food in the school noon meal programme, with its own packaged products, drawing sharp criticism from nutritionists and development experts. Packaged meals high in calories, sugar and salt are no substitute for fresh food and actually cause harm. They can only add to the risk of death by cardiovascular disease, estimated to be about five million by 2020. By contrast, a dramatic decline in death due to infectious diseases is projected. The agenda for social and political action is clear.