In the developing world, it is sadly still true that lack of access to food and medication are major causes of mortality. Yet even in the developed world, with its sophisticated food supply chain, its huge range of nutritional choices and its advanced healthcare infrastructure, many preventable diseases are shortening lifespans and leading people to live a significant portion of their lives in poor health. Furthermore, the problem is getting worse.
The latest Global Burden of Disease (GBD) study published by the Institute for Health Metrics and Evaluation – GBD 2017 – shows that dietary factors and the supply of healthy food are crucial in tackling the rising prevalence of non-communicable diseases (NCDs), which increase the costs of healthcare and reduce the capacity of the workforce. The study, which looks at trends in 195 countries and territories, and tracks 359 diseases and injuries as fatal and nonfatal causes of ill health, paints an alarming picture.
It found that from 1990 to 2017, there was a 41% decrease in communicable diseases and neonatal disorders, but simultaneously a 40% increase in NCDs. In developed countries, among the leading causes of early death were ischemic heart disease, stroke, lung cancer, COPD and diabetes. Worldwide, between 2007–17, mortality from cardiovascular disease increased despite the prevalence of costeffective drug treatments, and metabolic conditions such as diabetes and fatty liver disease increased the number of years lived with disability (YLDs).
In 2017, NCDs accounted for 80% of YLDs. Back in 2017, the World Health Organisation (WHO) noted that the number of obese children and adolescents worldwide had risen 10-fold in the past 40 years and that, if current trends continue, more will be obese than moderately or severely underweight by 2022.
The scale of the problem has led to much debate among regulators. A conference in Vienna, Austria, at the end of 2018 – ‘People’s food/people’s health: Towards healthy and sustainable European food systems’ – was among many recent forums of discussion among European agencies, governments and academics. It highlighted that dietary habits and physical activity are major considerations in Europe, where 60 million people suffer from diabetes, 55% of the adult population is overweight or obese, and two thirds of premature deaths are caused by four major NCDs – cardiovascular disease, diabetes, cancer and chronic respiratory disease.
Into this challenging environment has stepped Anne Bucher, director-general for health and food safety (DG SANTE) at the European Commission (EC), who took up her post in October 2018. In 35 years working for the EC, she has focused on policy areas such as economy and finance, development and social policy, taxation and the information society, giving her the breadth of experience needed to tackle such a complex brief.
“It has been a busy few months because there are many big topics on which we need to make progress,” Bucher remarks. “Food and health are big challenges and they must remain high on the agenda for the EU. We have priorities that are fixed by the legislative timetable, but we are seeing good results already.”
Regulations influence diet
The EC’s objectives in food safety and health are to guarantee a high level of protection of human life and health; the protection of consumers’ interests and fair practices in food trade; to ensure the free movement of food and feed manufactured and marketed in the EU; and to facilitate global trade of safe feed and wholesome food. One step forward under this brief was the recent agreement on the review of the General Food Law (GFL).
41%
A study found that from 1990 to 2017 there was a decrease in communicable diseases and neonatal disorders.
The GFL aims to enhance transparency and sustainability in the EU’s risk assessment model for the food supply chain. The goal is to strengthen the reliability, objectivity and independence of the studies used by European Food Safety Authority (EFSA), and to revisit the governance of EFSA in order to ensure its long-term sustainability. “We have just completed the review of the GFL, which makes science more transparent and which will make studies for risk assessment available to the public earlier,” Bucher notes. “The foundations of the EU’s food legislation are in the internal market. The monitoring of the market is centralised at EU level, and this is one of the most harmonised areas within the EU because there is an understanding that food must be safe and that we need to rely on scientific risk assessment.”
The new agreement stipulates that all studies and information supporting a request for a scientific output by EFSA are made public automatically when an application is validated or found admissible. This will be done at a very early stage in the risk assessment process, in an easily accessible electronic format that allows users to search, download and print the studies. There will also be a database of commissioned studies, consultations with stakeholders and the general public on submitted studies to ensure EFSA has comprehensive access to existing evidence underpinning its risk assessment, and a transparent procedure for consultation on planned studies.
40%
But simultaneously an increase in non-communicable diseases.
Institute for Health Metrics and Evaluation
EFSA will act to ensure coherent communication throughout any risk assessment in order to avoid any adverse impact on public perception as regards safety in the food chain, and to ensure that risk analysis is comprehensive, continuous and transparent.
“We need consumers to trust in the safety systems that are in place across the EU,” remarks Bucher. “Although individual member states control the enforcement of those systems, the EC can audit them. So, we have inspectors who can go to member states and look for problems with unsafe food or fraud. We saw that happen with horsemeat a few years ago, but we have the security system in place to detect these things.”
Grow with consumers
Food safety and nutrition are the focus for regulators across the world. Canada, for instance, saw the Safe Food for Canadians Regulations (SFCR) come into effect in January. Intended to strengthen Canada’s food safety system by focusing on prevention and allowing for faster removal of unsafe food from the marketplace, SFCR introduces new licensing, preventive control and traceability requirements for food businesses that import food or prepare food for export.
Whether in the EU, Canada or any other developed country, regulation needs to be constantly refined and updated, not least because consumers are more aware of and better informed about what they eat and where it comes from.
“Consumer demands have grown, so legislation must also evolve,” says Bucher. “We also have to ensure that food operators are compliant in terms of how they make and package food. Consumers want to be more informed and legislation imposes demanding food information obligations for producers. In this area, the EU is very advanced compared with the rest of the world.”
Currently, food producers must list all ingredients, the product’s origin, the presence of any allergens or genetically modified organisms (GMOs) and fat, salt and sugar content.
“The current debate is about whether we could add more information – such as the energy content, the nutrients contained in the food – and whether it is good or bad for your health. The food industry does, and has always done, voluntary initiatives, but we need to ensure that labelling is consistent and not misleading,” Bucher notes.
A little over a year ago, France adopted Nutriscore front-of-pack labelling, which grades the nutritional quality of food using a colour and letter coding system, to help consumers avoid eating an unbalanced diet. Many foods in Europe also feature a traffic light system, indicating high, medium or low levels of fat, saturated fat, sugar and salt. The debate is surely turning from food safety to the role of nutrition in the overall health of a society, and whether regulations can encourage, or at lease enable, healthy eating.
“Such labels must really be science-based and transparent for consumers,” continues Bucher. “NCDs are big challenges for our society and we must look at them in a holistic way that encompasses not just food, but also physical activity and lifestyle. We are doing a lot of work on tobacco at the moment. The EU has done a good job of looking at the impact of lifestyle on health, but obesity is just one example of a problem that we share with the rest of the world. That must be linked to food and our legislation on food health.”
A framework for food safety and health
Further regulatory developments in the EU include the recent introduction of rules limiting the amount of trans fatty acids (TFA), consumption of which is thought to elevate the risk of atherosclerosis. The content of TFA in food cannot exceed 2g per 100g of fat.
“There are also other initiatives, though not legislation, in the health area. Many of them are about the implementation at state level of NCD policies, such as providing support financing for the dissemination of information. In Sweden, for example, GPs are asked to prescribe physical activity, so we are supporting that approach with seed financing,” says Bucher.
“But it is not just about changing the medical profession,” she adds. “There are many stakeholders whose approaches need to be changed. We need to talk to people involved in education, agriculture, industry and more. For instance, we are involving the education system with a project to distribute fresh fruit in schools. We have to bring many different sectors together including nutritionists, public authorities, urban development agencies and civil society, in order to develop specific pilot projects.”
The Vienna conference called for a systemic approach to food and health to reduce diet-related diseases. Legislation involving tax, such as the UK’s tax on sugar, is for individual states to decide, but at EC level, the focus is on building a platform for engaging many different stakeholders and to create a holistic approach. The overarching framework is provided by the UN’s Sustainably Development Goals (SDG), which include eliminating child obesity by 2030.
“A lot of consultation is needed but food safety is an absolute imperative and it must be science-based,” stresses Bucher. “Food safety is the building block of legislation but the link between food and health is increasingly important. SDG is the holistic approach and it is very important. It covers everything including food policy, environmental policy and agricultural policy. We need that kind of overall framework in order to talk to all of the stakeholders in specific areas such as food.
“It can be difficult to communicate about how we already contribute to the overall well-being of citizens of Europe, and I would love to combat the fake news that is out there in order to build consumer trust in how we assess risk,” she adds. “I would love to highlight that at a European level. What we need to promote better health and better food safety is more science-based risk assessment – and less fake news.”
