RURAL ECONOMY Integrating Food Policy with Growing Health and Wellness Concerns: An Analytical Literature Review of the Issues Affecting Government, Industry, and Civil Society Sean B. Cash, Brett Cortus, Ellen W. Goddard, Alice Han, Mel Lerohl, and José Lomeli Project Report #05-01 Project Report Department of Rural Economy Faculty of Agriculture & Forestry, and Home Economics University of Alberta Edmonton, Canada Integrating Food Policy with Growing Health and Wellness Concerns: An Analytical Literature Review of the Issues Affecting Government, Industry, and Civil Society (Executive Summary and Full Report) Sean B. Cash, Brett Cortus, Ellen W. Goddard, Alice Han, Mel Lerohl, and José Lomeli Project Report # 05-01 A Report to Agriculture and Agri-Food Canada, Food Value Chain Bureau The authors are, respectively, Assistant Professor; Graduate Student; Chair; Research Assistant; Professor Emeritus; and Graduate Student, Department of Rural Economy, University of Alberta, Edmonton, Alberta. Integrating Food Policy with Growing Health and Wellness Concerns: An Analytical Literature Review of the Issues Affecting Government, Industry, and Civil Society A Report to Agriculture and Agri-Food Canada, Food Value Chain Bureau Executive Summary Sean B. Cash Department of Rural Economy University of Alberta 515 General Services Building Edmonton, Alberta Canada T6G 2H1 Information contained in this report consists of opinions expressed by the authors; consequently, the views expressed herein are those of the originators and do not necessarily represent the opinions of the department or the government of Canada. The Government of Canada and it employees, servants or agents make no representations or warranties as to the accuracy or completeness of the information contained in this report. Parties who rely on the information do so at their own risk. Executive Summary of Integrating Food Policy with Growing Health and Wellness Concerns: An Analytical Literature Review of the Issues Affecting Government, Industry, and Civil Society A Report to Agriculture and Agri-Food Canada, Food Value Chain Bureau, submitted May 2004, revised December 2004. Sean B. Cash, Department of Rural Economy, University of Alberta, 515 General Services Building, Edmonton, Alberta, Canada, T6G 2H1. Contact: [email protected], (780) 492-4562. Contact: Pam Ominski, Senior Market Analyst, Agriculture and Agri-Food Canada, 930 Sir John Carling Building, Room 5101, Ottawa, Ontario, Canada, K1A 0C5. [email protected], (613) 759- 7643. A recent letter to the editor printed in The Edmonton Journal ended with the question, “How many more needless deaths?”1 The letter was not addressing the violence in Darfur, distribution of pharmaceuticals, or AIDS – it was a comment on new dietary guidelines released a few days earlier in the United States. The tone of this letter highlights the growing concern over the linkages between food and health. Especially over the last ten years, such issues have received increasing public attention in both the policy and media arenas. One of the major drivers of public policy interest in this area is an increase in health costs that are attributable to diet-related causes. Lawsuits over issues of dietary liability, the popularity of books and movies such as Fast Food Nation and Supersize Me, and a barrage of quotable and terrifying statistics have all helped contribute to a growing consensus that we are facing a new crisis of food-related health concerns. If we are to address these concerns as a society, we must first recognize that consumer food choices are complex. Designing effective policies to change consumer attitudes may therefore be difficult and costly, and requires an integrated approach. Incentives offered to primary food producers, processors, retailers, and restaurateurs must be in line with societal goals, regulatory oversight must be consistent, and consumers must be provided with adequate information. In order to work toward better, more effective policies, it is desirable to review the actions and recommendations that the medical profession, multinational organizations, NGOs, the food industry, and national governments have undertaken. It is also important to assess the impacts of policies that have been proposed in other contexts, such as those developed to control the use of tobacco or those that govern the agri-food distribution system. To that end, University of Alberta researchers, at the request of Agriculture and Agri-Food Canada, undertook a literature review that addressed the following major areas: I. Part I consists of an overview of health and disease and the relationship between health and individual food consumption. Data are drawn from the medical literature. Discussion centres on a summary of various meta-analyses that link health to foods consumed. II. Part II summarizes major international organizations’ views about food health issues. We detail the FAO and WHO's positions on food and health and 1 “More Wheat, Less Rye,” Edmonton Journal, p. A13 (17 January 2005). Executive Summary – page 2 discuss the actions taken by various NGOs, including Canadian cancer and stroke organizations. III. Part III focuses on the food industry. The authors provide examples of the ways in which North American food firms have responded to health issues. This section also includes a summary of major food manufacturers’ product advertising activities. IV. Part IV centres on public policy issues, such as the development and marketing of the Canadian Food Guide and governmental regulation of advertising for individual foods. V. Part V includes a synopsis and recommendations for further research. The remainder of this paper provides a summary of the full document, prepared by Sean B. Cash, Brett Cortus, Ellen W. Goddard, Alice Han, Mel Lerohl, and José Lomeli for the Food Value Chain Bureau of Agriculture and Agri-Food Canada. All citations and references are provided in the full report. I. Overview of Health and Disease Issues Related to Individual Food Consumption Considerable research has been devoted to the relationship between the intake of individual food categories and the incidence of disease. In this review, the authors have focused on studies that concern coronary heart disease, cancer, stroke, and diabetes. In 1993, these four diet-related diseases accounted for an estimated $29.4 billion in direct and indirect health costs (calculated in 2004 dollars), or 19 percent of all Canadian health care costs. The deluge of dietary advice implied by these studies often bewilders consumers and policymakers alike. The reports, as reflected in the popular press, can often appear conflicting, or may seemingly require consumers to choose from a menu of disease risks they wish to face. For example, the consumption of ocean fish may provide important benefits in the fight against cancer and coronary heart disease, yet heavy metal pollutants in these same foods may cause nervous system and developmental problems. Although this review is far too brief to address many of these tensions, it does summarize the current knowledge about the relationships between the four diseases listed above and specific food categories of importance to Canadians. Specifically, the report summarizes research Executive Summary – page 3 linking coronary heart disease, cancer, stroke, and diabetes to the consumption of fruits and vegetables, meat, eggs, whole-grains, alcohol, sugar, dairy, fish, pulses, soy, and nuts. The studies reviewed suggest that fruit and vegetable consumption has a protective effect against coronary heart disease, cancer, and stroke; that meat consumption may be correlated with many forms of cancer; that moderate consumption of alcohol may help prevent coronary heart disease, stroke, and diabetes, while at the same time contributing to the risk of cancer; and that whole grain consumption may have protective effects against all of the diseases reviewed here. These findings are summarized further in Table 1 below. Table 1: Study Counts of Associations between Foods and Diseases CHD Cancer Stroke Diabetes P NE D P NE D P NE D P NE D Fruits and 16 8 2 2 Vegetables Meat 34 82 Eggs 1 Whole Grains 15 1 29 4 1 3 1 Alcohol 5 5 25 2 1 1 (Moderate Consumption) Sugar Dairy 3 2 11 Fish 8 3 24 6 2 1 Pulses 3 1 Soy Protein 41 5 Soy Isoflavones 4 1 Nuts 11 P = Protective; NE = No Effect; D = Detrimental II. The Multilateral and Non-Governmental Organizational Perspective Two multilateral organizations – the Organization for Economic Cooperation and Development (OECD) and the World Health Organization (WHO) – have shown significant interest in health issues. The OECD is an organization that has 30 members, who represent countries with developed economies. Its main health focus is on the costs and sustainability of health systems in member countries. The World Health Organization is a member organization of the United Nations, and represents countries at varying stages of the development cycle. It has long held the view that nutritional well-being maintains a fundamental role in health and human development, and its key Executive Summary – page 4 activities include nutrition promotion and the prevention and reduction of malnutrition. Accordingly, the WHO has been directly involved with the relationship between nutrition and human health. As a United Nations organization, the WHO has, for many years, commissioned or reviewed literature on diet and health. The WHO has identified nutrition as a major and modifiable determinant of chronic disease. This concern is reflected in the release of major sets of diet and health-related recommendations in 1990 and 2002. The differences between the 1990 and 2002 recommendations, highlighted in the full report, correspond to the evolving nature of the research base that links the two issues. However, the difference in the WHO’s recommendations also appears to reflect a decreased level of attention to issues of food inadequacy and a shift in focus toward issues of appropriate food selection. The perception appears to be that most of the countries of the world are able to provide adequate diets, at least in terms of calories.