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French Integrating Food & Health Policy Lit Review Exec Harmoniser la politique alimentaire et les préoccupations croissantes en matière de santé et de bien-être : une analyse documentaire des problèmes qui affectent le gouvernement, l’industrie et la société civile Rapport présenté au Bureau de la chaîne de valeurs d’Agriculture et Agroalimentaire Canada Résumé Sean B. Cash Département d’économie rurale Université de l’Alberta 515 General Services Building Edmonton (Alberta) Canada T6G 2H1 L'information contenue dans ce rapport provient d'opinions exprimées par le ou les auteurs et ne représente pas nécessairement celles du Ministère ou du gouvernement du Canada. Le gouvernement du Canada et ses employés, ses fonctionnaires ou agents ne font aucune déclaration et ne donnent aucune garantie quant à l'exactitude ou à l'exhaustivité de l'information contenue dans ce rapport. Les parties qui se fient à cette information le font à leurs propres risques. Résumé du document : Harmoniser la politique alimentaire avec les préoccupations croissantes en matière de santé et de bien-être : une analyse documentaire des problèmes qui affectent le gouvernement, l’industrie et la société civile Rapport présenté au Bureau de la chaîne de valeur des aliments d’Agriculture et Agroalimentaire Canada, soumis en mai 2004, révisé en décembre 2004. Sean B. Cash, Brett Cortus, Ellen W. Goddard, Alice Han, Mel Lerohl, et José Lomeli, Département d’économie rurale, Université de l’Alberta, 515 General Services Building, Edmonton (Alberta) Canada, T6G 2H1. Personne-ressource : [email protected], (780) 492-4562 Personne-ressource : Pam Ominski, analyste de marché principale, Agriculture et Agroalimentaire Canada, 930, Édifice Sir John Carling, Bureau 5101, Ottawa (Ontario) Canada, K1A 0C5. [email protected], (613) 759-7643. Une lettre récemment envoyée à l’éditeur en chef du Edmonton Journal se terminait sur cette question : « Encore combien de décès inutiles? »1 Elle ne faisait pas allusion à la violence au Darfour, à la distribution de médicaments ou au sida; il s’agissait plutôt d'un commentaire sur les nouvelles lignes directrices en matière d’alimentation publiées quelques jours auparavant par le gouvernement américain. Le ton de cette lettre met en évidence le fait que la population se préoccupe de plus en plus des liens qui existent entre les aliments et la santé. Depuis dix ans particulièrement, les questions touchant l'alimentation et la santé ont suscité de plus en plus d'attention, tant dans les milieux politiques que médiatiques. Une des principales causes de l’intérêt pour les politiques gouvernementales dans ce domaine concerne l’augmentation des coûts de santé attribuables au régime alimentaire. Des poursuites concernant des responsabilités alimentaires, la popularité de livres et de films tels que Fast Food Nation et Supersize Me, ainsi qu’un déluge de statistiques étonnantes et terrifiantes, ont contribué à accroître le consensus autour de l’idée que nous sommes confrontés à une nouvelle crise de confiance à l’égard de notre alimentation. Avant de nous pencher sur ces questions en tant que société, nous devons tout d’abord réaliser que les consommateurs se trouvent devant des choix complexes en matière d'alimentation. Il peut s'avérer difficile et coûteux de concevoir des politiques efficaces pour changer leurs attitudes. Pour y parvenir, il faudra recourir à une approche intégrée. Il est nécessaire que les mesures incitatives offertes aux producteurs d’aliments primaires, aux transformateurs, aux détaillants et aux restaurateurs soient conformes aux objectifs de la société, que le régime réglementaire de surveillance soit cohérent et que les consommateurs soient correctement informés. Cependant, pour élaborer des politiques meilleures et plus efficaces, il est souhaitable d’analyser les actions et les recommandations mises en œuvre par la profession médicale, les organismes multinationaux, les organisations non gouvernementales, l’industrie alimentaire et les gouvernements nationaux. Par ailleurs, il est important d’évaluer l’incidence des politiques proposées dans d’autres contextes, comme celles qui visent à contrôler l’usage du tabac et celles qui régissent le système de distribution agroalimentaire. Dans cette optique, les chercheurs de l’Université de l’Alberta, à la demande d’Agriculture et Agroalimentaire Canada, ont réalisé une analyse documentaire portant sur plusieurs thèmes présentés comme suit : I. La partie I offre une vue d’ensemble des questions de santé et de maladie et des relations existant entre la santé et la consommation alimentaire. Les données proviennent de la documentation scientifique. La discussion porte 1 “More Wheat, Less Rye,” Edmonton Journal, p. A13 (17 January 2005). Résumé – Page 2 essentiellement sur un résumé de diverses méta-analyses qui établissent des liens entre la santé et les aliments consommés. II. La partie II résume les points de vue d’importantes organisations non gouvernementales internationales sur les enjeux en matière de salubrité des aliments. Nous présentons en détail les positions de l’Organisation des Nations Unies pour l’alimentation et l’agriculture (FAO) et de l’Organisation mondiale de la santé (OMS) en matière d’alimentation et de santé. Nous examinons également les actions menées par diverses ONG, notamment les organisations canadiennes de lutte contre le cancer et les accidents vasculaires cérébraux. III. La partie III est consacrée à l’industrie alimentaire. Les auteurs présentent des exemples de la façon dont les entreprises alimentaires nord-américaines ont réagi aux questions de santé. Ils offrent également un sommaire des gestes posés par d’importants fabricants de produits alimentaires afin de promouvoir leurs denrées. IV. La partie IV porte sur les enjeux relatifs à la politique gouvernementale, comme la rédaction et la commercialisation du Guide alimentaire canadien et la réglementation publique régissant la publicité à l’égard de différents aliments. V. La partie V contient un sommaire et des recommandations pour les futures recherches. Les pages qui suivent présentent un résumé du document principal qui a été préparé par Sean B. Cash, Brett Cortus, Ellen W. Goddard, Alice Han, Mel Lerohl, et José Lomeli à l’intention du Bureau de la chaîne de valeur des aliments d’Agriculture et Agroalimentaire Canada. L’ensemble des citations et des références se trouve dans le document principal. I. Survol des questions de santé et de maladie liées à la consommation alimentaire Les liens qui existent entre la consommation des différentes catégories d’aliments et l’apparition des maladies ont fait l’objet de nombreuses recherches. Dans le cadre de cette analyse, les Résumé – Page 3 auteurs se sont concentrés sur les études qui portaient sur les coronaropathies, le cancer, les accidents vasculaires cérébraux et le diabète. En 1993, ces quatre maladies liées à l’alimentation ont coûté environ 29,4 milliards de dollars (en dollars constants, pour 2004) en frais directs et indirects, soit 19 p. cent du total des coûts de santé au Canada. Le déluge de conseils alimentaires qui découlent de ces études déroute souvent autant les consommateurs que les décideurs. Comme le montre la presse populaire, ces rapports paraissent souvent contradictoires ou semblent demander aux consommateurs de choisir parmi les risques de maladie auxquels ils s’exposent. Par exemple, si la consommation de poisson de la mer peut être très bénéfique pour prévenir le cancer et les maladies coronariennes, les polluants contenus sous forme de métaux lourds dans ces mêmes aliments sont susceptibles d’entraîner des problèmes du système nerveux et du développement. Bien que la présente analyse soit beaucoup trop restreinte pour pouvoir aborder un grand nombre de ces problèmes, elle résume les connaissances actuelles sur les relations existant entre les quatre maladies déjà mentionnées et les principales catégories d’aliments que consomment les Canadiens. Plus précisément, le rapport résume les recherches qui relient les maladies Tableau 1 : Dénombrement des relations entre aliments et maladies Coronaropathie Cancer Accident Diabète vasculaire cérébral (AVC) EP AE EN EP AE EN EP AE EN EP AE EN Fruits et 16 8 2 2 légumes Viande 34 82 Œufs 1 Grains entiers 15 1 29 4 1 3 1 Alcool 5 5 25 2 1 1 (Consommation Modérée) Sucre Produits laitiers 3 2 11 Poisson 8 3 24 6 2 1 Légumineuses 3 1 Protéines de 41 5 soya Isoflavones de 4 1 soya Noix 11 EP = Effet protecteur; AE = Aucun effet; EN = Effet néfaste Résumé – Page 4 coronariennes, le cancer, l’accident vasculaire cérébral (AVC) et le diabète à la consommation de fruits et de légumes, de viande, d’œufs, de céréales entières, d’alcool, de sucre, de produits laitiers, de poisson, de légumineuses, de soya et de noix. Les études analysées suggèrent plusieurs choses : la consommation de fruits et de légumes a un effet protecteur contre les maladies coronariennes, le cancer et l’AVC; il peut exister une corrélation entre la consommation de viande et plusieurs formes de cancers; l’apport modéré d’alcool pourrait contribuer à prévenir les coronaropathies, l’AVC et le diabète, tout en augmentant les risques de cancer; finalement, la consommation de céréales entières pourrait protéger contre toutes les maladies examinées dans ce rapport. Ces résultats sont présentés plus en détail dans le tableau 1. II. Le point de vue des organisations multilatérales et non gouvernementales Deux agences multilatérales, l’Organisation de coopération et de développement économiques (OCDE) et l’Organisation mondiale de la santé (OMS), ont toujours manifesté un grand intérêt pour les questions relatives à la santé. L’OCDE compte 30 membres qui représentent des pays développés. Cette organisation s'intéresse principalement aux coûts et à la durabilité des systèmes de santé des pays membres. L'Organisation mondiale de la santé est membre des Nations Unies et représente des pays qui se trouvent à divers stades du cycle de développement. L’OMS défend depuis longtemps l’opinion selon laquelle le bien-être nutritionnel joue un rôle fondamental sur le plan de la santé et du développement de l’être humain, et ses principales activités sont la promotion de l'alimentation et la prévention et la réduction de la malnutrition.
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