Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Lessons from the control of other epidemics
that a wider range of tools and approaches are
required. One approach has been the development
and adoption of codes of conduct that specify the
control of marketing and trade of goods felt to damage
public health. 11 Perhaps the most famous example
is that of the International Code of Conduct on
Breastfeeding Substitutes. This is a non - binding recommendation
adopted by the World Health Assembly
in 1981, with the purpose of promoting breastfeeding
and regulating the marketing of breast - milk substitutes.
However, this example also illustrates the limitation
of voluntary codes with numerous documented
transgressions of the Code by the breast - milk substitute
industry. 12 This has led to the recognition of the
need to develop more binding instruments.
In terms of binding instruments, the International
Health Regulations were adopted by the Assembly in
1948 in order to control the international spread of
communicable diseases. Most recently, the Framework
Convention on Tobacco Control ( FCTC ), is a binding
international convention, which aims to circumscribe
the global spread of tobacco use and tobacco products
(Box 2.1 ).
Legally binding instruments have the distinct
advantage that State Parties tend to comply, and the
disadvantage of a drawn - out process and the need
for global political support for a single solution.
Approaches which endorse binding international
instruments on food - related health issues have been
limited to food safety and security and, more recently,
discussions of rights - based approaches to undernutrition.
The non - binding intergovernmental resolution
has the advantage of flexibility. Potential international
standards and instruments in this area might address
issues such as marketing restrictions for unhealthy
food products, restrictions on the advertising and
availability of unhealthy products in schools, standard
packaging and labeling of food products, and potential
price or tax measures to reduce the demand for
unhealthy products. There is also the advantage of the
public attention surrounding the drafting of such an
instrument and the fact that it may set general standards
for corporate conduct without actually being
passed through legislation.
More recently, the importance of international
trade has put the relationship between trade agreements
and public health more in the spotlight. The
World Trade Organization ( WTO ) has become the
Box 2.1 WHO F ramework
C onvention on T obacco
C ontrol ( FCTC )
The WHO FCTC is the first global health treaty to be
negotiated under the auspices of the WHO. It was
developed in response to the globalization of the
tobacco epidemic and asserts the importance of a
broad range of strategies for demand reduction.
These include: price and tax measures; protection
from exposure to environmental tobacco smoke; regulation
and disclosure of the contents of tobacco
products; packaging and labeling; education, communication,
training and public awareness; comprehensive
ban and restriction on tobacco advertising,
promotion and sponsorship; and tobacco dependence
and cessation measures. There are also a
number of measures relating to a reduction in the
supply of tobacco including: elimination of the illicit
trade of tobacco products; restriction of sales to and
by minors and support for economically viable alternatives
for growers.
The treaty came into force on 27 February 2005,
and with almost 150 parties it is one of the most widely
embraced treaties in UN history. Notably absent from
the list of signatory countries are Russia and Indonesia;
the USA has signed but not ratified the treaty. The
challenge of implementation of the WHO FCTC
involves putting in place the required technical foundation,
translating the treaty into national laws, creating
strong mechanisms for enforcement, and then
monitoring their implementation. With about 25% of
adults smoking, there is a long way to go before
achieving full implementation of the treaty and a
reduction in the prevalence of smoking. The early
signs are encouraging with governments in low - and
middle - income countries such as South Africa moving
rapidly to legislate most of the provisions in the
Convention. National surveys show that the adoption
of this suite of broad legal and voluntary measures has
reduced smoking among the poorest sections of the
population by at least 30%.
arbiter of conflicts around the desire to reduce trade
barriers, on the one hand, and the need to protect
populations from harmful practices and goods, on the
other. For example, a government ’ s ability to establish
and maintain legitimate, non - discriminatory food
safety and food - related consumer information labeling
policies has been challenged as a barrier to free
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