Derek Yach

Major multinational food and beverage companies and informal sector contributions to global food consumption: implications for nutrition policy

BackgroundIn recent years, 10 major multinational food and beverage companies have worked together within the International Food and Beverage Alliance (IFBA) to increase their commitments to public health. Current IFBA commitments include initiatives to improve the nutrition quality of products and how these products are advertised to children. The impact and magnitude of IFBA member contributions to the total market share of packaged foods and beverages consumed remain incompletely understood, however.MethodsIn order to evaluate this impact, we examined packaged food and soft drink company shares provided by Euromonitor, an international independent market analysis company. Packaged foods include baby food, bakery, canned/preserved food, chilled/processed food, confectionery, dairy, dried processed food, frozen processed food, ice cream, meal replacement, noodles, oils and fats, pasta, ready meals, sauces, dressings and condiments, snack bars, soup, spreads, and sweet and savoury snacks. Soft drinks include carbonates, packaged fruit/vegetable juice, bottled water, functional drinks, concentrates, ready-to-drink tea, ready-to-drink coffee and Asian specialty drinks. We calculated the market shares for IFBA companies, globally and within nine countries--the US, China, India, Egypt, South Africa, Brazil, Mexico, Turkey and the UK.ResultsWorldwide, the top ten packaged food companies account for 15.2% of sales, with each individual company contributing less than 3.3%. The top ten soft drink companies account for 52.3% of sales worldwide; Coca-Cola and PepsiCo lead with 25.9% and 11.5% of sales, respectively.ConclusionsAlthough the top ten soft drink companies account for half of global sales, the top ten packaged food companies account for only a small proportion of market share with most individual companies contributing less than 3.3% each. Major multinational companies need to be joined by the myriad of small- and medium-sized enterprises in developing and implementing programs to improve the health of the public, globally. Without full participation of these companies, the impact of commitments made by IFBA members and other major multinational food and beverage companies will remain limited.

Globalization of Risks for Chronic Diseases Demands Global Solutions

Debates about globalization and health focus almost exclusively on communicable diseases. However, chronic diseases— especially cardiovascular diseases, cancer, chronic respiratory diseases and diabetes—now constitute the bulk of the global burden of disease. This chapter provides updated information on trends in the major macro-determinants of chronic diseases such as urbanization, globalization, and aging. Further, it summarizes evidence of the impact of known risk factors for chronic diseases such as tobacco, diet/nutrition, physical activity, and alcohol. Reasons for failure to invest in prevention are outlined and the importance of implementing available knowledge about preventive and therapeutic strategies is stressed.

Food companies and nutrition for better health

There is now broad acceptance that the future success of global health depends to a large extent upon sound nutrition and physical activity policies. Work with colleagues while at the WHO convinced me that such policies need to be developed and implemented in partnership with the corporate food sector if they are to achieve maximum impact. Soon after accepting my position at PepsiCo, Ricardo Uauy, President of the International Union of Nutrition Sciences, invited me to share my early views with colleagues in the hope of stimulating dialogue that would lead to health gains. I have spent the last two decades in community-based research and policy development in the public sector. For a decade I was involved in the development of South Africa’s epidemiological and public health capacity, before moving to WHO in 1995. There I led the development of a renewed global health policy entitled ‘Health for All in the 21st Century’ that updated and anticipated future changes not considered at Alma Ata in 1978. Among these were the need for a stronger focus on responding to the reality of globalization, the rise of chronic diseases and the importance of engaging partners from outside governmental, WHO and World Bank institutions. In contrast to several aspects of acute infectious disease control, including smallpox and polio eradication programmes, I saw that these emerging challenges demanded new forms of partnering that draw upon many sectors and would require resolving many competing development priorities. This is particularly important as we seek ways to effectively tackle the complexity of nutrition transition. Evidence about the negative epidemiological and economic consequences of unhealthy diets and a lack of physical activity on health increases every year. It now conclusively shows that, without attention to these areas, global gains in health brought about by declines in infectious diseases will be eroded by the rapid emergence of chronic diseases. The WHO and FAO have responsibilities between them for developing international norms and standards for food and nutrition policy. They do this by working closely primarily with national governments. Their statements and documents have an impact on national priorities and policies. For example, WHO Technical Report Series no. 916 of 2003 provided the science base for implementation objectives outlined in the Global Strategy on Diet, Physical Activity and Health which was adopted by all governments in May 2007. Several of the objectives required changes in the composition of foods, in the way they are marketed and the priority that should be given to physical activity. These changes are well beyond the scope of WHO, FAO, non-government organizations (NGO) or governments to implement alone, and many fall directly within the ambit of food companies and other corporations. Food and beverage companies have the resources and the reach, not to mention a strong profit motive, to make products and conduct their business in ways that benefit their consumers. Taste, convenience, price and health are all elements that determine what consumers eat. Leading food and beverage companies are increasingly being judged by investors and consumers on the basis of how they meet all these consumer needs, including health aspects, and not just on sales. Worldwide, health concerns like obesity have emerged as major drivers of which products are sold and how they are sold. NGO, legislators and consumers seek authentic action by the companies they support that shows how the company is responding to nutrition needs by changing its product portfolios and the way those products are marketed. When we look back a decade, the notion of private– public partnerships in health has not been broadly accepted. In fact, deep ideological differences led to academics who partnered with corporations (then mainly pharmaceutical companies) being subject to hostile responses. Despite this, public–private partnerships have led to new pharmaceutical products being developed and priced in ways that allow for better control of many infectious diseases; and to new ways of working in communities. The time has come to apply knowledge of what works best to keep such partnerships focused on achieving practical outcomes for obesity and related health concerns. However, unlike so many other major public health threats, there still is no example of a sustained decline in obesity in a large population outside a war or famine. The trend lines in developed and developing countries remain upward. We all have our views about what would work best. We need to maintain a reasonable degree of humility about what will really work. And be open to testing different solutions. I have always sought to work where the potential for health gain is great. It was a privilege to be at WHO when we had support to move the public health agendas on tobacco, mental health and then diet and physical activity ahead. The process of developing WHO’s first treaty,

The role of business in addressing the long-term implications of the current food crisis

Before the onset of the current food crisis, the evidence of a severely neglected nutrition crisis was starting to receive attention. Increased food prices are having severe impacts on the nutritional status of populations. Our current food system has evolved over decades in a largely unplanned manner and without consideration for the complexity and implications of linkages between health, nutrition, agricultural, economic, trade and security issues. The underlying causes for the nutrition crisis include the above, as well as decades of neglect with regard to nutrition, and agricultural science (especially in emerging markets); a failure of governance with respect to the major players involved in nutrition, a weak response by government donors and Foundations to invest in basic nutrition (in contrast to growing support for humanitarian aspects of food aid), and a reluctance to develop private-public partnerships. The emergence of new business models that tackle social problems while remaining profitable offers promise that the long term nutrition needs of people can be met. Businesses can have greater impact acting collectively than individually. Food, retail, food service, chemical and pharmaceutical companies have expertise, distribution systems and customers insights, if well harnessed, could leapfrog progress in addressing the food and nutrition crises. While business can do lots more, its combined impact will be minimal if a range of essential government actions and policies are not addressed. Governments need to create innovative and complementary opportunities that include incentives for businesses including: setting clear nutritional guidelines for fortification and for ready-to eat products; offering agreements to endorse approved products and support their distribution to clinics and schools; eliminating duties on imported vitamins and other micronutrients; and providing tax and other incentives for industry to invest with donors in essential nutrition and agricultural research. Currently governments in developed countries provide a wide range of incentives to the pharmaceutical industry to develop medicated solutions to nutritional problems. We need equivalent effort to be given to the development of more sustainable agricultural and food based solutions. We now face a truly global set of interlinked crises related to food that affect all people. The same degree of urgency and high level leadership and partnership seen during the Second World War is required on a global basis. This time it will need to simultaneously address agricultural, environmental and health considerations with the aim being the attainment of optimal nutrition for all within a framework of sustainable development.

Comprehensive cancer control-research & development: knowing what we do and doing what we know

Comprehensive cancer control is defined as an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality across the cancer control continuum from primary prevention to end-of-life care. This approach assumes that when the public sector, non-governmental organizations, academia, and the private sector share with each other their skills, knowledge, and resources, a country can take advantage of all its talents and resources to more quickly reduce the burden of cancer for all its population. One critical issue for comprehensive cancer control is the extent to which the private sector can contribute to cancer prevention and control programs and policies that have historically been lead by the public health sector, and similarly how can the public sector increase its investment and involvement in clinical research and practice issues that are largely driven by the private sector worldwide? In addition, building capacity to integrate research that is appropriate to the culture and context of the population will be important in different settings, in particular research related to cancer control interventions that have the capacity to influence outcomes. To whatever extent cancer control research is ultimately funded through the private and public sectors, if investments in research discoveries are ultimately to benefit the populations that bear the greatest burden of disease, then new approaches to integrating the lessons learned from science with the lessons learned from service (public health, clinical, and public policy) must be found to close the gap between what we know and what we do. Communities of practice for international cancer control, like the ones fostered by the first three International Cancer Control Congresses, represent an important forum for knowledge exchange opportunities to accelerate the translation of new knowledge into action to reduce the burden of cancer worldwide.

Innovative Business Approaches for Incenting Health Promotion in Sub-Saharan Africa: Progress and Persisting Challenges

Non-communicable chronic diseases related to behaviors such as tobacco use, overeating, excess alcohol intake and physical inactivity account for increasing morbidity and mortality in South Africa. Over the last 15 years, Discovery Health, the largest private health plan in South Africa, has developed a voluntary health promotion program called Vitality with over 1.5 million members. Vitality was designed with many applications drawn from the growing field of behavioral economics, including the use of incentives and rewards. Incentives offered on the program are aimed at lowering the financial barriers to activities such as visiting the gym, buying healthy food or receiving preventive screening. Members accrue points for engagement which translate into discounts on a range of goods and services. Although the full impact of the program cannot yet be quantified, engagement with the program is continually increasing and there is compelling evidence that this translates into better health and cost outcomes.

Chapter 9 – The Balance Between Regulation and Private-Sector Initiative in Securing Healthy and Sustainable Food

This chapter analyzes partnerships between agrifood firms, regulators, consumer groups, and international organizations. It identifies the circumstances under which these partnerships are likely to bring the greatest benefits and discusses future trends in food supply, safety, and regulation.