Chitra Subramaniam | Dr. Franklin Apfel
When renowned Master Chef Jamie Oliver spoke at the annual gathering of public health leaders in Geneva last week, people paused. They listened as he joked asking, “…what the hell is a Chef from Britain doing here.” The packed room broke into applause when he spoke of the sugar tax he pushed in his country. What did he say to make that happen that others have not said in recent years about world malnutrition, obesity and policy lethargy?
Oliver’s message was packaged differently, not in the language and form of a doctor but that of a campaigner and an advocate who speaks simple and factual truth to power. In Oliver’s case, that is amplified through his 5 million plus twitter and Facebook followers. This week the world celebrates a day dedicated to the global fight against tobacco. The nicotine delivery device kills one million Indians (6 millions in the world) annually. The truth about this hazard merchant was blown out of the water by court action in the United States (US), most significantly in the state of Minnesota. As we write, campaigners are taking on the European Union (EU) for caving-in to industry pressure about their Audio Visual Media Services Directive (AVMSD) protecting children from alcohol advertising.
Tobacco solutions came from relentless campaigning by lawyers and lawsuits some fifty years after the medical evidence of their cancer causing properties were in. Solutions to what Oliver calls “the avalanche of processed foods” will come from people like him who are on the frontline of nutrition and have in Oliver’s words “realised that they have a responsibility to speak out” to extend their platforms, engage, agitate and push through legislation. The battle against drunken-driving was led by mothers and victims of reckless driving. People are generally ahead of their governments – responsible advocacy is their legitimate tool.
Oliver has indeed stirred the pot and shows us that it is possible for people working in an industry to question its ethics and it is possible to shake the tree you are sitting through what he calls “smart commitments.”
Yes, Oliver is doing exactly that. He is dragging corporations to account, not just count. “I understand governments, I know big business and I have been disrupting and working for change in nutrition for the last 20 years,” says the Master Chef whose restaurants train former offenders as Chefs and are also vehicles for advocacy and change. Oliver was the most high profile face calling for a sugar tax in UK on high-sugar drinks, particularly fizzy drinks most popular among teenagers. Thanks to his data-driven advocacy there will now be two bands – one for total sugar content above 5g per 100 millilitres, and a second, higher band for the most sugary drinks with more than 8g per 100 millilitres. Full strength Coca Cola and Pepsi are prime candidates for this tax. Pure fruit juices and milk-based drinks are excluded from this tax as are the smallest producers.
Oliver’s Food Revolution that is active in 130 countries across 200 platforms (and at the time of writing counts already 711,529 revolutionaries) is what he calls a “single voice in a choir” hoping to buck the trend of childhood obesity on the one hand and grave malnutrition on the other. Some 800 million people in the world are malnourished and 2.1 billion or 30% of the world is obese. Ahead of his remarks to the WHA Oliver tweeted to Indian Prime Minister Narendra Modi asking him to make what he calls smart commitments which are specific, measurable, attainable, relevant and time-bound. India has the highest number of malnourished children in the world and that 22% of Indian adults are obese. “I will spend the rest of my life educating people about this” Oliver told health ministers from over 195 [SC1] countries. In the same session where Oliver spoke, the representative of health ministry of Chile held up a box of sugar coated breakfast cereals to hammer the message home noting his SMART commitment to regulating such products. .
So what is advocacy?
Advocacy assumes that people have rights and responsibilities to hold governments to account for their health generating or harming polices. It works best when it is focussed on something very specific for which data is available. Tobacco, alcohol, sugar and fat are all prime targets because the harm they cause is documented. They fall in the category of communicated diseases – the vector here is advertising and marketing. Marketing to children is a major issue.
Advocacy is primarily concerned with benefits to which people have a right or are entitled to. All countries signatory to the WHO charter have Right to Life in their constitutions. People have a right to know what is in the food they eat. They are entitled to know what hazard merchants are doing to hook them early and keep them addicted whether it is to fizz drinks, alcohol, tobacco or fatty foods.
Over a dozen Health Ministers or their direct representatives including the US, UK, Canada, Australia, Chile, Mexico, Kenya and the Netherlands were present with Oliver to make SMART commitments to action. Among the interventions were labelling changes (e.g. Black discs placed on high sugar, fat and salt cereals and snacks as children are sensitive to colours), advertising bans, directives and partnerships with the food industry, access to nutrition for all and education as the vital enabler of a sensible dialogue.
The battle – yes, it is one – to protect future generations from becoming victims of hazard merchants will have to be continuous and unrelenting. It is almost certain that solutions will not come from health ministers until advocates like Oliver hold up mirrors to the very industry they work with. Advocacy is not linear. Its often two steps forward one step back. Last week the WHA lost a bid to write in new guidelines on baby foods (the authors will address this issue in another post). The draft for revised rules to protect children in the EU from being exposed to alcohol advertising on a daily basis fails to keep abreast with the competition that liberalisation of broadcasting advertisement times.
Big steps were taken this week in the world of public health with Oliver asking this question of their governments – do lawmakers have a licence to fatten and/or starve their future generations and if so who gave them this right?
Public health advocacy brings best evidence to people so they can make informed choices about what they eat and drink and what their lawmakers are doing or not doing. Oliver said he recognised that he was in an “unusual setting,” and he reminded people that it was their “responsibility” to shift the bar and that he himself had walked from being a “Naked Chef” to a food revolutionary. Voices like that of Oliver are about as good as it gets. The question no longer is what the hell is a Chef from Britain doing here. It is why on earth are not more people following his recipes?
(Dr. Apfel is a medical doctor and a public health advocate. He is Managing Director of the UK-based World Health Communications Associates (WHCA). www.whcaonline.org)
More links to our coverage of nutrition and childhood obesity from #WHA69