Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 2
other non - communicable disease epidemics, such as
tobacco control, cancer control, diabetes and HIV/
Aids. This chapter does not aim to re - state the control
strategies being employed or go into details of specific
interventions. Rather, it seeks to identify essential
principles that have been critical for scaling up
approaches to the various non - communicable disease
epidemics in order to suggest some priority actions for
addressing the childhood obesity epidemic.
In no particular order they are as follows:
Shifting from an i ndividual to
p ublic h ealth a pproach
Traditional responses to the control of non - communicable
disease arose from the results of large longitudinal
studies of men in places such as Framingham
in the United States. 2 These studies followed up
thousands of middle - aged men in order to isolate a
number of important risk factors for heart disease and
other non - communicable diseases. The control strategies
that arose from such an approach focused on
isolating individuals with risky lifestyles or risk factors
and prescribed relevant behavior changes through
health education to the population and, possibly,
treatment for those at “ high risk ”. However, this
approach has been very expensive and in itself had
limited impact. In particular, it has been the realization
that a large number of people at a small risk may
give rise to more cases of disease than the small
number who are at high risk, 3 that shifted attention
to interventions that could make a difference at a
population level as exemplified by this insight into
controlling blood pressure: “… a 2% reduction in of
mean blood pressure … has the potential to prevent
1.2 million deaths from stroke (about 15% of all
deaths from stroke) and 0.6 million from coronary
heart disease every year by 2020 in the Asia Pacific
region alone … and could be readily achieved in many
populations by reducing the salt content of manufactured
food ”. 4
Analysis of large - scale examples of significant
reversals in the prevalence of risk factors or reductions
in mortality from non - communicable diseases from
places such as Norway, Poland and Mauritius 5 – 7 has
identified important structural interventions. Such
interventions include a combination of selective agricultural
subsidies, price manipulation, retail regula-
tions, and clear labeling. For example, in the case of
Norway this was based on a wide range of measures
that included: 5
• public and professional education and
information;
• setting of consumer and producer price and income
subsidies jointly in nutritionally justifiable ways;
• the adjustment of absolute and relative consumer
food price subsidies, ensuring low prices for food
grain, skimmed and low - fat milk, vegetables and
potatoes;
• the avoidance of low prices for sugar, butter and
margarine;
• the marking of regulations to promote provision of
healthy foods by retail stores, street vendors and
institutions; and
• the regulation of food processing and labeling.
Shifting from an i nternational to a
g lobal p ublic h ealth a pproach
Traditionally, international public health approaches
have viewed national governments as the primary
agents and locus of control for public health. Global
threats are primarily conceived of as problems of
border control and dealt primarily through cross -
border cooperation between governments. The legal
instruments are confined to national legislation and
regulations. The scope of activities is also mostly
focused on targeting risk factors in prevention programmes
based in the Ministry of Health. 8
However, experiences from global efforts to control
tobacco consumption or restrict the marketing of
breast - milk substitutes suggest that such an approach
is not sufficient. 9 In both cases attempts to influence
the production, marketing and distribution of these
products through general education, national campaigns
or appeals to industry have been found to be
necessary but not sufficient to have a real impact. 10
The accelerating pace of globalization has resulted in
many health determinants being constituted beyond
national or even regional boundaries. 8
Quite clearly, the de - linking of many health determinants
from national space, requires a much broader
response than that traditionally associated with
the international approach. A wider range of actors
and stakeholders, both governmental and non -
governmental, need to be involved. It also suggests
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