Nutrition / Public Health

Marion Nestle, Thomas Farley, Sue Atkinson, and Derek Yach: Summary Of The Tisch Public Health Forum On Food Policy And Obesity

On Tuesday, January 29th, four food policy experts sat down to discuss policies in responses to obesity at the 2013 Joan H. Tisch Public Health Forum. The event was held at Hunter College’s Roosevelt House, moderated by Senior Editor of The Atlantic, Corby Kummer. Below is a summary of the night’s proceedings, divided by speaker:

THOMAS FARLEY, Commissioner, New York City Department of Health and Mental Hygiene (NYC DOHMH)

Thomas Farley started the discussion by presenting a slightly new angle. He noted that the health department’s 3 goals for the city of New York include: 1) increasing access to fresh fruits and vegetables; 2) reducing the over-abundance of sugary drinks and snack foods; and 3) something that hasn’t been mentioned in the past – counter-acting the promotion of “unhealthy foods,” a term long considered taboo.

Among the DOH’s laundry list of program, the latest initiative taken by the DOH is in fact an old one. The department plans to revive efforts to remove remove SNAP (Supplemental Nutrition Assistance Program) subsidy for sugar-sweetened beverages, or restricting the purchase of sugary drinks with SNAP benefits. Farley admitted that there is “no single policy” that will alleviate the city’s public health issues, and this last initiative “just adds 1 item to the list.” The proposal was originally shot down by the USDA in 2011.

SUE ATKINSON, Joan H. Tisch Distinguished Fellow in Public Health at Hunter College, Visiting Professor, University College London, and former Director of Public Health London and Health Adviser to Mayor and Greater London Authority

Along with Farley, Sue Atkinson served as the forum’s second voice for municipal government. “Much more can be achieved at city level,”  she stated, but she made it clear that London focuses more on “public health, not food necessarily.” London only launched their Health Improvement Board (HIB) in 2011, compared to NYC’s Health Department which dates back to 1866. The HIB differs from London’s current NHS (National Health Service), the latter bearing more responsibility for strategic planning and oversight, much like London’s mayor, who doesn’t have the same level of power as Bloomberg in NYC, possibly due to London’s 30 boroughs compared to NYC’s 5.

In contrast to NYC’s top-down approach, policies in London are normally kick-started voluntarily with donations, then later picked up by local boroughs and supplemented with local funding. For this reason, London has found it essential to work with local organizations for program sustainability. Some of London’s programs are similar to NYC’s, such as London’s Breakfast Club program (NYC’s Breakfast in the Classroom), but are fed primarily through a notion of “education” rather than health. Similarly, London’s Fresh Carts (NYC’s Green Carts) is less focused on deprived areas and more focused on serving as a business model to increase jobs.

The Well London program takes on a community-development approach, calling upon 25 deprived areas of London to choose what they wish to change in their community, funded by $9.5 million in Lottery money. The program provides cooking lessons for a population going on to 3 generations of no cooking skills. The program also gave rise  to the Extended School program, similar to the Cincinnati Model, a type of join-use agreement that enables schools to serve as central hubs for after-school programming.

DEREK YACH, Senior Vice President, The Vitality Group, Former Executive Director of the World Health Organization, head of  Global Health at the Rockefeller Foundation, and Senior Vice President for Global Health and Agriculture Policy at PepsiCo.

Derek Yach began with a quote by Benjamin Franklin that contradicted Farley and Atkinson, “A man convinced against his will is of the same opinion still,” referring to the top-down approach by the NYC health department. Yach went as far as to accidentally refer to the NYC mayor as “the President,” stirring an uneasy laugh from the crowd.

In response to Farley’s policies, Yach noted a 2 year initiative by health care giant Humana Inc. Humana partnered with Discovery South Africa to offer 350,000 Humana enrollees a 25% discount on “healthy foods” as incentive for being healthy and active. Humana is now partnering with Walmart to bring the program to the U.S., starting with a 5% discount program on items specially marked as, “Great For You.”

However, the initiative in South Africa hasn’t seen an impact on obesity, and Yach firmly believes that food initiatives, including those in NYC, won’t make a dent in body weight if not paired with a portion size component. He hopes that large-scale government-private partnerships can solve this issue, noting the recent pledge by 16 food industries to remove 1.5 trillion calories from the marketplace by 2015 as part of the Healthy Weight Commitment Foundation (HWCF), being overseen by UNC research professor Barry Popkin.

In response to Atkinson’s school breakfast programs, Yach stated that that the U.K. Change4Life program was a massive investment by Quaker-Tropicana’s Magic Breakfast. The NGO offers long-term breakfast programs to the poorest schools in London. Corby made it evident to audience that Quaker and Tropicana are both owned by Pepsi Co, to which Yach is affiliated with.

MARION NESTLE, Paulette Goddard Professor, Department of Nutrition, Food Studies and Public Health, New York University

“Let’s just get right to it,” Marion Nestle started. Following Yach, who is tied to PepsiCo, Nestle found it humerous to note, “I have tenur,” referring to her freedom of expression. Nestle focused on two of her better-known arguments,  “Food choices aren’t made in a vacuum,” thus government regulation is necessary, but “Eating less is very, very bad for business,” suggesting that there will always be push-back from the food industry at any “utilitarian” approach by the government to enforce portion control.

Nestle cited the recent 16 oz. cap on sugary drinks by the NYC DOH, which caused an outcry by the beverage industr. By using a “divide and conquer” technique, Nestle claims that the beverage industry labelled the government’s public health approach as “racist,” winning over organizations such as the National Association for the Advancement of Colored People (NAACP) and the Hispanic Federation“We don’t have class in America. We have race, which is used as a proxy for class.”

Farley suggested that the industry spent anywhere between $75 to $125 million to oppose restrictions on soda, to which Derek Yach (PepsiCo) blushfully noted, “You range is correct.” To show an example of where the money was spent, Nestle noted that young adults were paid $30 per hour to wear t-shirts opposing the “Soda Ban” in NYC’s Union Square. Nestle’s solution remains fairly top-down, closing with a remark on junk food advertising to children, noting cities with restrictions, such as Quebec.

Summary
Based on Farley’s commentary, the term “unhealthy” is no longer taboo. However, the government should expect to receive backlash for repeated top-down approaches, such as the reactions to NYC’s recent cap on sugary drinks. Switching to community-driven programs from the bottom-up, as described by Atkinson, may be more acceptable in certain situations. In addition, these programs focus away from food and center more on jobs and education, thus allowing for greater collaboration. Yach adds that the most successful programs include a portion size component, and government-private partnerships may be the answer, but not the full answer; Nestle would agree that top-down approaches are necessary to counter industry propaganda.

You can watch the full full forum on livestream here.

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