Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Developing the political climate for action
The contrasts in the responses to
food safety and diet - related
disease issues
The response to the risks of bovine spongiform
encephalopathy ( BSE ) is instructive. Decisive action
was resisted initially as there was great uncertainty
about a little understood infective agent, a prion, and
fairly clear evidence already that there were species
barriers in the susceptibility of different species to
prions. So the UK Minister of Agriculture repeatedly
denied that there was any danger from eating BSE -
infected meat products, for example, from some types
of fast food. However, 10 years after one of the authors
(WPTJ) was alerted confidentially to the development
of the BSE outbreak in cattle, there was suddenly a
cabinet crisis in 1996 when the head of the Expert BSE
group, Professor John Pattison, insisted throughout
several hours of grilling by the Prime Minister and his
senior colleagues that the first 10 cases of a new strain
of Creutzfeldt – Jakob disease (new variant CJD) must
be assumed to arise from infected beef (personal communication).
Quite dramatic moves on BSE were
made by the UK Prime Minister within 24 hours
because at that stage it was recognized that the agent
had the potential to infect huge numbers of the population
(numbered then at up to 8 million) and this
would affect individuals randomly with a ghastly and
inevitably fatal disease. Scientific guesswork, the presumed
manipulation of evidence by ministers and the
political pressure to protect the long - term interests of
the farming and food sectors, magnified the alarm of
the public, media, some sections of the medical profession
and ministers themselves. So this was a major
crisis in political, economic and social terms. The beef
bans, changes in farming practice and removal of beef
export licences that followed cost the UK tax payer
over £ 6 billion and the ensuing changes in Europe cost
far more.
Figure 25.1 shows the array of major factors that
influence public thinking on risk in general and how
these factors relate to the public ’ s perception of the
risks of BSE.
The contrast with such issues as obesity, diabetes,
or coronary heart disease (CHD) is striking. Yet the
draconian measures for handling BSE were taken
on far less evidence than that which underlay the
dietary basis for the hundreds of thousands of deaths
from CHD and the contrast with the governmental
effort to prevent CHD is striking. No country
has spontaneously introduced major strategic
changes in food policies on the basis of analyses of
chronic diseases and their risk factors by government
expert committees. 1 CHD is still the biggest contributor
to deaths and CHD and cancers in the UK continue
to account for more than two thirds of
preventable UK deaths, that is, in those under 75
years. Yet the only issue which resonates in political
circles is the higher death rate among the poorer
classes and the failure to treat cases promptly and
adequately.
The problem is that it is almost universally assumed
that diet depends on an individual ’ s choice and that
while the consequences are hazardous, heart attacks
and strokes occur later in life and “ one has to die of
something ” . Type 2 diabetes was seen as an unfortunate
condition in the elderly and really linked to a
family history of susceptibility. The dreaded risks of
cancer were not linked to diet, but to pesticides and
chemical carcinogens, which governments still try to
understand and limit by engaging large groups of
experts. Thus, the public health response to the post -
war epidemic of CHD in Europe and North America
has depended on groups of cardiologists initiating
public debates and proposing changes. This, in turn,
has stimulated the food industry to respond by producing
lower - fat milks, butter and spreads, and
changes in the fatty acid content of foods, thereby
providing themselves with excellent marketing material!
In every case where political action has been
taken there has been political pressure from highly
vocal individuals or groups within the academic
community or civil society. Furthermore, despite the
preventability of Type 2 diabetes, until very recently
no effort had been made by doctors, or even by
the specialist interest groups, to address its prevention.
The huge charitable organizations that fund
research on heart disease, stroke, diabetes and cancer,
pump millions of dollars into basic research and
improved treatment, but support almost nothing
in prevention. Indeed, many of the heart foundations
and cancer charities have either simply paid lip
service to the preventive issue or even attacked preventive
initiatives because they were based on crude
measures or could demonstrate no “ proof ” of their
effectiveness.
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