South-East Asia Regional Conference on Epidemiology

<strong>South</strong>-<strong>East</strong> <strong>Asia</strong> <strong>Regional</strong> <strong>Conference</strong> on Epidemiology | 199
The figure here illustrates the core components of within- and cross-systems analyses through
a diagnostic of actors, motivations, trends, governance, and other institutional arrangements that
contribute to organizational choice and shape the environment in which individuals, family and
communities operate. As can be seen, each system is comprised of first-level core subsystems – here
identified as the nature of the system and its attributes; the core production units of the system, the
main stakeholders involved at individual level as well as in local, national and global governments, in
the private sector, and at community levels, and the various types of governance and rules – which are
each made of second-level variables, then decomposable in deeper-level variables (7). The Societal-
Level Diagnostic proceeds through knowledge synthesis and field examination for six levels of
analysis: (i) the system attributes; (ii) the system outputs; (iii) stakeholders; (iv) rules and governance;
(v) the interactions between stakeholders; and (vi) the outcomes in regard to healthy eating and
physical activity, within social, economic, cultural, legal and political settings at local and national
levels, taking into consideration the global-level sphere of influence as well.
Conclusion
In regard to diet-related health outcomes, individuals as well as communities, organizations and
systems interacting in contemporary societies to drive food supply and demand have complex motives
and operate on multiple scales to generate productive and innovative as well as destructive and perverse
outcomes for society as a whole, as well as for themselves and their respective sectors. This applies in
particular to industries whose offerings shape the dietary energy balance, whether through agriculture
and food, television and media, computer and other technologies or through transportation and urban
planning. Centres of decision-making that are formally independent of each other become, in fact, part
of the same system. Together, this produces deeply-nested challenges in aligning modern society with
the power and limits of human biology where health, economic performance and other local, national
or global outcomes cannot be targeted and monitored independently of each other.
These ‘nested challenges’ have thus far not been addressed successfully because of the clear
boundaries set by the two-pronged institutional frameworks underlying modern society since the onset
of the Industrial Revolution. This framework is anchored, on the one hand, in market mechanisms
aligning industry supply with consumer demand and, on the other, in social and political governance
for market regulation and non-market domains, such as health and human development, funded by
taxes and other public or philanthropic sources. It is assumed that what business does best is doing
business and, therefore, health and other social parameters should remain peripheral to the strategic
agenda. As good members of society, corporations are expected to pay taxes and to comply with
regulations, when these are deemed necessary to solve or prevent ‘market failures’.
Complex nested health challenges, such as obesity and chronic diseases, differ from other health
problems where precise ‘market failures’ can be easily singled out as causal agents (food safety
or tobacco, for instance). In these latter cases, precise and strict regulations can be developed and
reinforced to eradicate such toxic agents. The policy battle over obesity and chronic diseases is shaping
up to resemble the tobacco policy battle of the 1990s and it bears pointing out that a key element in
that battle was the scientific evidence that nicotine was addictive, a process not unlike the wired-in
impulsive response to food and food cues in the environment. Governments are already using some of
the policies that were used to combat smoking: taxation, prohibition and health warnings.
At the same time, food is not a toxic substance to eradicate because of the potential negative
long-term impact of its excessive consumption, such as tobacco. It is the fuel that our species have
learned to rely on for survival that has become too easily accessible through agricultural and industrial
development. Food is also a hedonistic and symbolic object imbued with one’s personal, social and
cultural identity. Health and other motives which underlie food choice are intrinsic components of the