The global triangle of obesity, undernutrition, and climate change represents ‘The Global Syndemic’ — the greatest threat to human and planetary health, researchers say. The underlying causes of this syndemic are commercial vested interests, lack of political leadership, and insufficient societal demand for change.

Image in public domain.

A Global Syndemic

“Syndemic” is not a word you hear very often — and you most definitely don’t want to hear. It represents an aggregation of two or more epidemics or diseases which exacerbate the total damage. The ‘Global Syndemic’ refers to the devastating combination of obesity, undernutrition, and climate change — which a new report published in the Lancet identifies as the single largest threat to mankind and Earth.

Excess body weight is estimated to affect 2 billion people worldwide, causing 4 million deaths every year. At the same time, stunting and wasting affect 155 million and 52 million children worldwide, respectively; 2 billion people suffer from a micronutrient deficiency, and 815 million people are chronically undernourished. Malnutrition is the single biggest cause of ill-health globally. Climate change is already affecting the lives of most people on Earth, with devastating consequences. Even from a purely economic standpoint, these issues account for an excess of 20% of the global GDP — but from a humanitarian perspective, it’s an unmitigated disaster.

The first thing we must change, the Lancet Commission on Obesity argues, is our perspective. These three issues are generally regarded as separate — but they share a common backbone: a global policy focusing on economic growth, ignoring negative health effects, environmental damage, and social inequality.

“Until now, undernutrition and obesity have been seen as polar opposites of either too few or too many calories. In reality, they are both driven by the same unhealthy, inequitable food systems, underpinned by the same political economy that is single-focused on economic growth, and ignores the negative health and equity outcomes. Climate change has the same story of profits and power ignoring the environmental damage caused by current food systems, transportation, urban design and land use. Joining the three pandemics together as The Global Syndemic allows us to consider common drivers and shared solutions, with the aim of breaking decades of policy inertia,” says Commission co-chair, Professor Boyd Swinburn of the University of Auckland.

The effects of these issues are also intertwined. For instance, climate change will disproportionately affect the underdeveloped parts of the world, bringing even more food insecurity and extreme weather events. Fetal and infant malnutrition has also been shown to increase the risk of adult obesity, and climate change also increases the price of numerous food commodities, especially fruits and vegetables, which can fight global obesity. Overall, things revolve in a connected triangle, making each other worse, just like several diseases can make each other worse by collapsing the immune system.

The solutions, therefore, must also act on all these issues in conjunction.

“We must recognise these connections and implement double-duty actions that address both obesity and undernutrition and triple-duty actions that influence multiple parts of the syndemic simultaneously,” says Commissioner Professor Corinna Hawkes, City University London (UK).

It sounds weird to say that measures against obesity would also fight climate change (and vice versa), but here’s a very simple example: what if we were to tax red meat? Red meat requires a disproportionate amount of resources, produces a huge amount of greenhouse gases, and at the same time, it is a major contributor to the global obesity crisis. The tax money could be used to alleviate world hunger or promote healthier and more sustainable alternatives. Supporting active transportation in the form of walking, cycling, or using public transportation is another excellent example: this could reduce some of the greenhouse gases coming from transportation, while at the same time making people more healthier and alleviating infrastructure strain as a bonus.

So why aren’t we doing more of this?

Vested interests

The reason, the report explains, is shockingly straightforward: powerful vested interests oppose it. It’s very rare to see a scientific report being so trenchant about something so delicate, and that’s exactly what makes it so important to heed its warning.

Image in public domain.

Economic power has been increasingly concentrated into fewer, larger companies. These companies are investing heavily in lobbying to promote their own policies and reject any health-based policy that would attack their profits.

It’s well known that major fossil fuel companies have denied climate change for decades, even though they knew it was happening as a direct result of their activities. At the same time, subsidies from the US government keep the price of oil artificially low — subsidies which would be better diverted towards more sustainable forms of energy. Attempts to include sustainability in national dietary guidelines in the USA and Australia failed as a result of corporate lobbying from the food industry, which pushed to remove sustainability from the terms of reference. Lobby from the sugary drinks industry has also been very successful against local initiatives to reduce soda consumption, and it research funded by this industry is five times less likely to find an association between sugary drinks and obesity compared to other studies.

All in all, it seems that this financial and market power of the world’s major companies translates into political power, preventing regulation that would be beneficial for people.

“With market power comes political power, and even willing governments struggle to get policies implemented against industry pressure. New governance dynamics are needed to break the policy inertia preventing action. Governments need to regain the power to act in the interests of people and the planet and global treaties help to achieve this. Vested commercial interests need to be excluded from the policy table, and civil society needs to have a stronger voice in policy-making. Without disruptive change like these, we will continue on with the status quo which is driving The Global Syndemic,” says Commissioner Tim Lobstein, World Obesity Federation

What should be done

Researchers are calling for a new worldwide social movement — which again, is highly unusual for a scientific report. Lobstein and colleagues say we need to radically rethink the relationship between the important players: policymakers, business, governance, and civil society. Since the business is the main driver of this situation and the governance and policymaking side also seem content with this status quo, it seems like the only potential source of change is the civil society. Effectively, all possible strategies that would fight this syndemic require larger support from all of us.

Not only do we need to make better individual decisions when it comes to our own lifestyles, but we need to push policymakers in the right direction and encourage them to make more sustainable decisions. Supporting businesses which take steps in the right direction is also important, as is not supporting the ones that don’t.

This type of social mobilization can work. We’ve seen the intention of the US administration to withdraw from the Paris Agreement, which itself is seen by many as not ambitious enough — so political deals can be surprisingly fragile. But even in this situation, 2,700 leaders from US cities, states, and businesses representing 159 million people and US$ 6.2 trillion in GDP have developed an alliance and continued to mitigate the effects of climate change. In Mexico and the UK, mobilization against sugary drinks has led to the implementation of a tax, despite strong resistance from the industry.

The businesses don’t need to be on the losing side of it, either. Of course, things like sugar, which have a clear negative effect (called a negative externality), should be taxed — but the only unfair thing is that this hasn’t happened so far. Similarly, the world’s leading economists are advocating for a carbon tax. But this all opens up new avenues for sustainable business models, the likes of which can turn a profit while not doing environmental and health damage. Furthermore, the incentive is to make the switch as early as possible but again, the drive needs to also come from the social level — from each and every one of us.

“The past few years have seen renewed activism at the local level, whether in cities, communities, or in particular issues. As with other social movements, such as campaigns to introduce sugary drink taxes, efforts to address the Global Syndemic are more likely to begin at the community, city, or state level, and subsequently build to a national or global level. Support for civil society is crucial to break the policy deadlock and the systems driving the Global Syndemic,” concludes Professor Dietz.

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