03 Oct

Sweet Poison; the Politics of Health Governance

Posted By Politybooks

Obesity is forever being discussed by the media, reported increases in obesity rates are frequently featured in the news and there are many documentaries that discuss the ‘problem’. Those individuals who are obese often experience stigma (see chapter 4), and are blamed for their individual choices which many see as the cause of obesity. Familiar arguments include ‘people should do more exercise’ and ‘they need to take more responsibility for their diet’ – they permeate the media and indeed our own societal discourses. Indeed, such arguments are not exclusive to obesity as our moral judgements extend to alcohol consumption and tobacco usage too. Do you subscribe to these views? Have you considered the broader influences upon individual health that have contributed to obesity? Contemporary Health Studies encourages the reader to think about many health issues in their broader context, reflecting upon the wider determinants of health. Thus, obesity is discussed in chapter 10 when we examine the physical environment and its impact upon our health (see page 217). Readers are also asked to think about all of the influences upon obesity (learning task 13.1, page 281) and strategies to tackle the problem (learning task 13.2, page 286) in chapter 13. If you have completed these tasks, did your reflections include thinking about industry and the commercial determinants of health, as recently discussed in our last blog? Did you consider the relationship between the governance of food and obesity, for example? The global power and importance of the sugar industry versus individual health outcomes related to obesity? 

Recent media coverage has interestingly returned to the governance of sugar within our diets (see the  BBC and Telegraph). Obesity and the consumption of sugar are linked and this has led to calls for increased governance of sugar consumption. The need for healthy public policy (defined in chapter 11) in this area is not a new debate. This issue has been visited, and indeed revisited by the World Health Organisation (WHO) which first made the recommendation that sugar should not make up more than 10% of our total calorie consumption per day in 2002. Fourteen years ago, the WHO’s work focused upon the development of a global strategy to reduce risk factors for chronic disease, including obesity. In 2003 the WHO published a research report that advised restricting the intake of added sugars to 10% or less of daily calories. The fall-out from this report was very interesting to say the least, sugar industry groups of course strenuously objected, and they enlisted the help of US senators from sugar-growing states which led to pressure for large amounts of American funding to be withdrawn from the WHO. The overall result was a much watered down version of the 2002 recommendations, released in 2004, in the WHO’s Global Strategy on Diet, Physical Activity, and Health. This strategy did not mention the original 2002 report, or the 10% sugar recommendation. Their suggestions from 12 years ago were significantly changed (Zaracostas 2004) because for many the power and might of the sugar industry won the battle against the health opponents.

The health opponents are once again preparing for battle: these issues have not gone away. Obesity rates continue to rise with well documented impacts such as increased health risks, and increasing health-care related costs as a result of more children being admitted to hospital with obesity-related issues. Consequently there are now calls for more radical control of sugar within our daily diets including increased taxes. However, the power of industry also remains. Industry has both its own interests and well-documented ways in which to influence governance processes; and so the battle continues and the question remains as to who will ultimately win the war. 


Zarocostas J. (2004) WHO waters down draft strategy on diet and health. Lancet; 363:1373 (see http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)16090-X/fulltext#article_upsell )
Louise Warwick-Booth, October 2014