World Health Organization’s Credibility Problem

January 29th, 2015 by MorganDowney Leave a reply »

The World Health Organization (WHO) plays a vital role in fighting everything from ebola to avian flu and a hundred other communicable and non-communicable diseases. In recent years, non-communicable diseases (NCDs) have assumed greater importance as major communicable diseases have declined and the impact of NCDs has increased.

So, it was of some interest when the WHO recently issued its 2014 Global Status Report on NCDs. WHO’s Global Target #7 is “Halt the Rise in Diabetes and Obesity.”  (Ok, it isn’t exactly “Remember the Alamo!” but it is their target.)

The report, directed to senior health ministers around the world, states in its Executive Summary:

Obesity increases the likelihood of diabetes, hypertension, coronary heart disease, stroke and certain types of cancer. Worldwide, the prevalence of obesity has nearly doubled since 1980. In 2014, 11% of men and 15% of women aged 18 years and older were obese. More than 42 million children under the age of 5 years were overweight in 2013. The global prevalence of diabetes in 2014 was estimated to be 9%. Obesity and diabetes can be prevented through multisectoral action that simultaneously addresses different sectors that contribute to the production, distribution and marketing of food, while concurrently shaping an environment that facilitates and promotes adequate levels of physical activity. Diabetes risk can be reduced by moderate weight loss and moderate daily physical activity in persons at high risk. This intervention has been scaled up to the whole population in a small number of high-income countries. However, it is difficult to implement this intervention at scale in low- and middle-income countries, partly because current methods for identifying people at high risk are cumbersome and rather costly. Further research is urgently needed to evaluate the effectiveness of interventions to prevent obesity and diabetes.

The main body of the report asks, “What are the cost-effective policies and interventions for reducing the prevalence of obesity and diabetes?” Good Question. Unfortunately, WHO offers a bad answer:

Although evidence on what works as a package of interventions for obesity prevention is limited, much is known about the promotion of healthy diets and physical activity, which are key to attaining the obesity and diabetes targets. Evidence of population-wide policies and settings-based and individual-based interventions that have worked are described below.

Population-wide policies

Evidence suggests that changes in agricultural subsidies to encourage fruit and vegetable production could be beneficial in increasing the consumption of fruits and vegetables and improving dietary patterns. (Ed: citation is discussed below.) Evidence strongly supports (Ed: same citation) the use of such subsidies and related policies to facilitate sustained long-term production, transportation and marketing of healthier foods.

Let’s look at what the WHO considers to be “evidence”. One paper is cited for “evidence”. Written by David Wallinga, director of the Food and Health Program, Institute for Agriculture and Trade Policy in Minneapolis, MN, titled, “Agricultural Policy and Childhood Obesity: A Food Systems and Public Health Commentary” (Health Affairs, 2010;29(3):405-10), it is an expansive, creative foray in possible changes in agricultural policy in the United States in anticipation of the reauthorization of the Farm Bill.

Let me draw your attention to the word “Commentary” in the title because that is exactly what it is. The paper, which is quite good and worth reading reviewing the history of US agricultural policy which has evolved to favor “cheap calories”. The author reflects that perhaps it is time to shift to an agricultural policy which favors the production of fruits and vegetables. He makes a very nuanced observation that, “Diets rich in fruits and vegetables can help manage weight and can lower risks for cancer and other chronic diseases, especially when they replace calorie-dense, nutrient poor foods.” In addition to using the qualifying verb “can”, Wallinga offers no citations for this assertion but that is not the point. Maybe it is my legal education but I think “evidence” means something more than philosophical on what might be the effects of future policy changes at all levels of government and affecting many vital economic sectors. I doubt Mr. Wallinga would consider his paper to be “evidence” of anything. For WHO to call it “evidence” to the intended audience of health ministers is simply misleading. Worse, it assumes that the only intervention they might make are enormous changes in their countries agricultural programs. Since agriculture is a major economic sector in most countries, such an approach is likely to be, well, fruitless.