By George Thurley

The authoGeorgeTr is Policy Officer for Healthy Trade and Food, Drink and Agriculture at the European Public Health Alliance (EPHA). He works on EPHA’s Food, Drink and Agriculture and Trade for Health campaigns, helping to advance healthy European food and trade systems. George has experience working to create positive change in European Union policy, having previously campaigned on various issues, including the environment, resource justice and trade.

Diet is the foremost risk factor for non-communicable diseases (NCDs): the average European consumes too much sugar, too much saturated fat, and too much salt. The share of people who are overweight or obese has steadily increased between 2010 and 2014 in almost all European countries.[1] As such, the multitude of overlapping initiatives and policies that govern Europe’s food – from agriculture policy, to marketing rules, and trade deals – have a considerable impact on health, and the increase in NCDs.

At the end of June, during the “Civil Society Trade Lab”, a high-level event jointly organised by ten civil society organisations including EPHA, stakeholders came together to discuss how EU trade policy contributes to this situation, and – more importantly – how to develop an alternative approach to promote a healthy food and farming system, including reversing this growing public health burden.

Current trade policy tends to encourage an export-led agriculture system, resulting in lower prices, but also promoting a yield maximisation approach which takes less account of the types, and nutritional quality of the food produced. The link between trade and NCDs goes deeper: a correlation between the rise in overweight and obesity and a country’s integration into globalised food supply chains has been observed.[2] Foreign direct investment (FDI) by transnational food companies has been identified as a particularly potent indicator of increased accessibility of highly processed foods high in fat, sugar and salt (HFSS).[3] By altering the local availability, nutritional quality and desirability of foods, these changes affect population diets and raise increasing concerns about the rise of obesity and NCDs.

Pricing: a thorny issue for health, farmers and consumers

Consumer food prices are at the heart of the debate. Market prices for many commodities do not cover most farmers’ costs, meaning they are often obliged to produce as much as possible, and look for export markets to make a living.

Likewise, consumer price is an issue for health, as liberalising trade deals tend to reduce the price of unhealthy foods, leading to increased consumption and worsening health.[4] Tariff reductions as part of trade deals make food ingredients cheaper, irrespective of their nutritional qualities, encouraging manufacturers to use more of those ingredients, and can also increase investment by food companies. There is growing evidence that people consume more junk food after their governments sign free trade agreements – as high-margin high value products like soft drinks and snacks are often the foods most affected by liberalisation. For example, soda consumption in Mexico increased by 37% between 1998 and 1999, as NAFTA was negotiated and implemented.[5]

CASE STUDY: NAFTA and Mexico’s Obesity Problem 

From 1988 to 1999, the period in which NAFTA was negotiated, signed and put into effect,

The average energy from fat in the Mexican diet increased from 23.5% to 30.3%;[6]

Consumption of refined carbohydrates increased by 6.3%;[7]

Soda consumption increased by 37.2%.[8]

Food prices are therefore both too low to provide for farmers’ livelihoods, and too low to account for the negative effects on the environment and health caused by their production, processing and distribution. Surely then, measures to increase the price of certain commodities, with farmers receiving a fair proportion of the final value of their produce, would present a straightforward solution?

However, there is the small problem of public demand. Most Europeans expect the prices of food to remain low, or even continue falling relative to household budget – an argument often used to reject policy action to address food’s contribution to NCDs.  One of the most common arguments against taxes on sugar-sweetened drinks is that they would unfairly penalise the lowest socio-economic groups of society as price rises will affect them the most.

However, the lowest-income groups are also the most sensitive to falling prices. When trade deals tend to reduce the price of foods, there is also a strong correlation between poverty and diet-related NCDs. According to the Organisation for Economic Development (OECD), increased affordability of food is one of the factors responsible for the rise of obesity, especially among low-income groups.[9] Falling relative prices and increased affordability of food have contributed to up to 40% of the increase in body mass index in the United States in the period 1976 to 1994.[10] Keeping food prices artificially low therefore simply displaces the costs of their production to another part of the system, namely health services.

Food policy: the need for a systemic approach

Clearly then, neither food price rises nor falls are unambiguously positive or negative, and can have numerous different impacts which need to be managed. As noted by Professor Olivier de Schutter at the Food and Trade lab event “cheap food is currently used as a substitute for social policy.” It seems perverse that our lack of action to tackle inequality through social policy is used as a reason to stymie change in food or trade policy.

At the same time, the Sustainable Development Goals show the need for coherent and comprehensive action to tackle global challenges. Goals 2 (‘End hunger, achieve food security and improved nutrition and promote sustainable agriculture’) and 3 on (‘Ensure healthy lives and promote well-being for all at all ages’) are particularly relevant in this context.

In order to ensure that diverse policy areas, including trade, do not threaten, or impede, efforts to reverse the epidemic of noncommunicable diseases through preventative measures, there is a clear need for a holistic food policy to deal with the complexity of our economic and social systems, and to balance various areas as diverse as trade, health and fiscal policy. Such a food policy could, for example, develop ways to counteract the effect of more expensive food through social policies to give the poorest families more purchasing power while ensuring farmers’ receive a fair price for producing food to a high standard. A food policy worthy of the name, which could balance all these various priorities, and take a systemic approach to better health and nutrition, would go a long way to tackling Europe’s NCD crisis.

[1] WHO Europe (2015) European Health Report 2015

[2] Boyd Swinburn et al. (2009) Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr., Yevgeniy Goryakin et al. (2015) The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries. The Lancet

[3] Corinna Hawkes (2005) The role of foreign direct investment in the nutrition transition. Public Health Nutr.

[4] EPHA Consultation Response on 2016 TTIP Sustainability Impact Assessment, 9 June 2016

[5] Anne Marie Thow and Corinna Hawkes (2017) The Implications of Trade Liberalization for Diet and Health: A Case Study from Central America. Globalization and Health 5

[6] Rivera, Juan A; Barquera, Simon; Campirano, Fabricio; Campos, Ismael;  Safdie, Margarita and  Tovar, Vıctor (2002) Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity, Public Health Nutrition: 5(1A), 113–122

[7] Barquera, S., Campos, I. and Rivera, J. A. (2013), Mexico attempts to tackle obesity: the process, results, push backs and future challenges.

[8] Jiménez-Aguilar A, Flores M, Shamah-Levy T. Sugar-sweetened beverages consumption and BMI in Mexican adolescents. Mexican National Health and Nutrition Survey 2006. Salud Publica Mex

[9] Franco Sassi (2010) Obesity and the Economics of Prevention – Fit not fat. OECD.

[10] 0 D. Lakdawalla et al. (2002) The Growth of Obesity and Technological Change: A theoretical and Empirical Examination. National Bureau for Economic Research. Working Paper W8946.