Boyd Swinburn: Health Minister sets shameful legacy

Toddler formula has significant downsides.

New Zealand and other dairy producers block effort to regulate exploitative promotion of processed formula.

There were high hopes for improving child nutrition at the World Health Assembly, the annual gathering of health ministers at the World Health Organisation in Geneva the week before last. But backroom pressure from rich countries such as New Zealand, to drive their commercial trade priorities ahead of public health, soon hit home.

First was the uplifting declaration of the United Nation's Decade of Nutrition Action to reduce the enormous burden of undernutrition and overnutrition, now called 'malnutrition in all its forms'. This is the biggest cause of ill health and health inequalities in almost all countries, including New Zealand.

In many developing countries, undernutrition is only slowly declining while obesity is rapidly increasing. The declaration was also recognition that the food systems creating this burden of malnutrition are broken and need fixing. Its lofty visions with no fine print were widely supported with applause.

The second agenda item of interest, especially to New Zealand, was the report of the Commission for Ending Childhood Obesity co-chaired by the Prime Minister's chief science adviser, Sir Peter Gluckman. A young Kiwi mother, Jasmine Crosby, gave an impassioned speech on how childhood obesity was impacting on her Maori community. She called on governments to show leadership and the report was endorsed by the health ministers the next day.

But what about the next week or the next year? Will those ministers return to their countries and implement the top three recommendations in the report - serious funding for food literacy, taxes on sugary drinks and regulating junk food marketing to children? Can Kiwi kids, the third fattest in OECD countries, rely on their Health Minister to convert his yes vote in Geneva into action at home?

The third agenda item directly pitted commercial trade interests against children's nutrition, with food industry lobbying "assuming absurd proportions", according to one WHO source. What was the issue at stake? A measure to end inappropriate promotion of foods for infants and young children recommended the marketing of all milk formula products, including those designed for toddlers, be regulated under the WHO code which covers infant formula.

These processed, expensive products are often sweetened and flavoured and are heavily marketed to mothers in developing countries as follow-up formula or growing-up milks for toddlers. There is bitter experience in those countries of exploitative marketing tactics implying boosted physical and intellectual development for children.

Toddler formula has significant downsides. It is vital to protect the first 1000 days of the lives of children from the intrusion of ultra-processed foods which set children's taste preferences for foods and drinks high in sugar and salt and put them on a path to obesity, diabetes and heart disease. Developing countries also want to protect their local cuisines and food systems from domination by multinational food corporations. The dairy industry has created a demand for these expensive, unnecessary products and successfully lobby governments to block regulations to restrict their marketing.

Where did New Zealand stand in this debate? We led the charge, with the US, EU and Canada, to oppose restrictions on marketing.

Behind closed doors, the rich, milk-exporting countries prevailed and the final resolution was so watered down that formula companies face no immediate prospect of having their marketing practices regulated in any way.

The final related agenda item was a proposal to protect the WHO's independence from the undue influence of the private sector. Managing relationships where there are major conflicts between commercial interests and public health interests is critical when it comes to developing public policy. Yes, the food industry must be part of the solutions to fix our broken food systems, but no, they should not be dictating public policy.

Unfortunately, this resolution was also heavily watered down. It left plenty of loopholes for industry to continue lobbying as usual.

What was the legacy our representatives delivered at the start of a Decade of Nutrition Action? A cynical yes to child obesity recommendations and back-room bullying to water down protections for child nutrition. Surely we can do better than that.

Boyd Swinburn is Professor of Population Nutrition and Global Health at the University of Auckland.