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Food and Health in Europe: a New Basis for Action

Posted on: Friday, 11 February 2005, 03:00 CST

Food and health in Europe: a new basis for action, WHO Regional Publications, European Series No. 96, A. Robertson, C. Tirado, T. Lobstein, M. Jermini, C. Knai, J.H. Jensen, A. Ferro-Luzzi and W.P.T. James, Editors (WHO Regional Office for Europe, Copenhagen) 2004. Pages 388. Price: Sw. fr. 100/-US $ 90.00, ISBN 92 890 1363 X

During the past two to three decades, the perspectives of nutrition have been totally transformed with several paradigm shifts. The present book is the brain child of the WHO Regional Committee for Europe to enable WHO to implement its first food and nutrition action plan for European Region (ER). The book consists of four major sections: (1) Diet and disease, (2) Food safety, (3) Food security and sustainable development, and (4) Policies and strategies with an initial overview and final conclusion with each of these sections being supported by recent and relevant literature.

The first chapter of the book starts with an illuminating walk through mortality and morbidity due to diet related chronic diseases as well as deficiency disorders which are still encountered in certain parts of Europe (eartern). The vast differences in the region in intake of fruits, vegetables, fish and milk fat and the nutritional problems are well illustrated with mortality data on cardiovascular diseases (CVD), coronary heart disease (CHD), cancers, neural tube defects and prematurity. Evidences presented indicate that causally and chronologically the demographic, nutritional and epidemiological transition can be interlinked where urbanization, food supplies and dietary patterns move in parallel directions. The authors clearly trace the path and the shift from pure cereal/legume-based food and fruit/vegetables based diets to processed foods, foods of animal origin, refined foods (sugars), alcohol and salt accompanied by changes in physical activity due to mechanization and prevalence of several degenerative disorders. Country case studies reflect on health care costs in different countries of ER, attributing variations in mortality due to CVD to social inequalities and poverty, diet induced risk factors particularly of saturated and trans fatty acids (due to hydrogenation), Omega 3-fatty acids and sudden cardiac deaths due to arrhythmias. Role of vegetables and fruits versus pharmacological supplement of antioxidants (largely ineffective) and dietary approaches to stop hypertension (DASH) trials, are addressed in addition to harmful effects of processed foods and red meat, and the epidemic of cancer and of overweight and obesity in relation to energy balance and its consequences, with specific reference to abdominal distribution of fats, implications of childhood obesity and physical inactivity and most of other issues. The insights provided and the nuanced analysis on the structural, social and cultural dimensions, costs and accessibility to both food and exercise suggest that choices are governed by these important issues.

Chapter 2 discusses food safety and control which are of interest to public, politicians and government officials in Europe. The region has witnessed rising incidence of food borne diseases, new hazards in food chain and its sweep across border due to globalisation of the food trade. Both biological and chemical contaminants, their effects particularly on children and the aged groups, extent and magnitude of problems in different countries have been projected as evidences for developing surveillance and strengthening national reporting systems. Disease burden due to food borne episodes have been presented in relation to economics and political consequences. Risk assessment has been stressed as the most scientific method of qualitating health risks and ethical issues. The need for food control systems to improve food technology and to promote global trade as central to public health warrants the attention of all concerned. WHO apparently has a special role to play by way of advocacy, assistance for developing integrated food safety systems, developing scientific tools to measure problems in food chain and management of food borne risks and risks communication.

The third chapter has fundamental aspects of food and nutritional security which impinge on human health, dignity and sustainability in production with repercussions on the ecosystem. The chapter has dealt with the convoluted interrelationships of food/nutrition, production and ecological degradation and environmental health. The editors point at the fact that food security must be replaced by nutrition security and have given detailed accounts of local initiatives needed with emphasis on community action, national strategics (country specific), co-ordinated approaches among diverse ministeries/departments/policies. While policies support global trade and modern farming and expanded food production, it has its own repercussions on viability of small food business and totally leads to privatization. The hidden costs of agriculture create environmental problems which must be a lesson for developing countries which are already struggling to raise the nutritional status.

These indirect costs are due to excessive use of fertilizers, pesticides, deforestation, degeneration of soil and water and air pollution (oxygen depletion), high treatment costs, biodiversity losses and damage to health which are a burden to the society and health services. Perishable foods such as fish, fruit and vegetables have limited availability and financial support. Animal-derived products lead to a shift in agricultural land for livestock use. A shift thus has reflected on nutritional quality and health related problems. Further distribution, pricing policy, processing, advertising and market issues add to health problems. This chapter has interesting and illuminating facts on the biodiversity and the biochemical diversity (nutrients and phytochemicals), fat composition of animal meat, processing and nutrition quality, highlighting the quantity versus quality dimension in every aspect and the decline in health and ecosystems. Reduction in food transport and change in farming have been suggested to curtail demands on natural resources. The chapter narration is lively and has science-based data which should serve as an eye opener for countries in transition. The book has colleted the vicissitudes of food and nutrition scenario during the last few decades and woven into the analysis of strategies and practices which have adverse impacts on the health scenario with positive suggestions for better future.

The fourth and the last chapter's main focus is on policies and strategies and provides a frame work within which Member States can address nutrition and food security, safety and sustainable development (social and environmental) which can stimulate rural economics as well. The emphasis of the chapter is on integrated policies, intersectorial co-ordination and on commitment to public health of all citizens.

After unfolding a synoptic picture, disadvantages of discordant and advantages of concordant policies have been outlined. The editors feel that EU is the biggest importer and exporter of food in the world and hence its policies on nutrition related aspects will affect all countries. Their taxation, pricing policies and subsidies conflict with health goals of decreasing animal food and fat and increasing vegetables /fruits intake in all segments of population.

The Swedish recommendation to phase out aid to dairy products, limit the school milk measures to low fat milk and introduce measures of fruits and vegetables in school programmes, redistribution of agriculture support to favour horticulture produce and to develop a plan to phase out tobacco subsidies, is expected to have a salutary effect on several chronic problems. While consumption of olive oil is good, ELJ policies to promote olive production has resulted in severe soil erosion and a decline in water availability. The food safety, environmental sustainability and excess production, must run in parallel direction without harmful interactions.

The existing policies (in all regions) on nutrition, food safety and security have been discussed, with clear considerations for the future with emphasis on key elements of success and obstacles to development and implementation of concordant policies. The population-based nutrient recommendations, food-based dietary guidelines at national level, and how to adopt it to country's needs have been clarified. Food legislation, labelling and food control policy and risk analysis, HACCP approaches and how to go about the complex and exciting job of agreement is dealt with in an enlightening and lucid manner pinpointing to the interplay of the good, adverse and destructive influences on appropriate issues.

The book highlights the crucial role of planning processes to bring about uniformity for developing countries to shape their policies and programmes encompassing nutritional and food security, ecological balance and sustainability with beneficial impacts on social and economic development. The well presented country case studies, the valuable guidance given in the form of relevant tables, charts, annexures and literature and the critical analysis of facts is very educative and informative. Though a large volume of literature is available on the issues discussed in the book it is a comprehensive treatise on related aspects of food and nutr\ition and the editors have taken pain to deal with every aspect. It is a significant addition to books on nutrition and food security, safety, sustainability and their impact on nutrition and health with emphasis on policies and will interest scientists, industrialists in food trades, policy and decision makers.

In conclusion it is a comprehensive regional publication of WHO which underlines the need for an uncompromising pursuit of the context in the analysis of the complexities of dietary intakes of populations. The book makes a reappraisal of food and nutrition scenario with suggestion for remedial measures for better public health in EU Region and is certainly a valuable asset to existing literature.

Kamala Krishnaswamy

H.No. 2-98/2, Sriniketan

Kakateeyanagar Colony

Habsiguda

Hyderabad 500007, India

Copyright Indian Council of Medical Research Dec 2004

Source: Indian Journal of Medical Research

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