The global headlines are often dominated by climate change, famine and the growing rates of obesity- all of which contribute to the worldwide burden of disease. Much work has been done over the past two decades to understand the complexity of obesity, and in the last decade, climate change and its impacts on the health of nations is being highlighted, often via the lens of denial of said impact.
A new report commissioned by the Lancet started with the charge of addressing obesity but added the pandemics of undernutrition and climate change to form a global syndemic. Taking a system approach Boyd Swinburn from the University of Auckland, New Zealand and colleagues peel back the layers of complexity within each pandemic, namely within obesity, undernutrition, and climate change to provide policy levers and paths forward to address this syndemic.
Globally the rates of obesity continue to increase, this despite many localized efforts to address policy, food and physical activity environments. Malnutrition, which includes obesity and undernutrition continues to impact developing and developed countries. The commission points to five specific feedback loops to contribute to the systemic nature of how these pandemics overlap. They include:
“(1) governance feedback loops that determine how political power translates into the policies and economic incentives and disincentives for companies to operate within;
(2) business feedback loops that determine the dynamics for creating profitable goods and services, including the externalities associated with damage to human health, the environment, and the planet;
(3) supply and demand feedback loops showing the relationships that determine current consumption practices;
(4) ecological feedback loops that show the unsustainable environmental damage that the food and transportation systems impose on natural ecosystems; and
(5) human health feedback loops that show the positive and negative effects that these systems have on human health. These interactions need to be elucidated, and methods for reorienting these feedback systems prioritized to mitigate The Global Syndemic.”
The authors provide an excellent example of how complex addressing these policy levers can be- think about the national dietary guidelines in the USA, a lengthy process involving some of the best scientists in food and nutrition that often gets bogged down by lobbyists for various nutritional components of the US food ecosystem (sugar, salt, dairy, meat, beverage industries etc.). What we tend to end up with is an amalgamation of the science and lobby positions that also feeds into how the farm bill funds get distributed.
There are only a few exceptions globally, like Brazil and Sweden who have also considered the climate change impacts of how food is farmed and processed, and those guidelines lean more into plant-based dietary patterns that support environmental sustainability. Mapping the local ecosystem where people live, work, play, pray, and learn is essential to tease out the local policy levers that can positively impact health, like public transport which can support someone getting their recommended 30 minutes a day of physical activity. It is possible along that commute corridor that the food environment can also be influenced to be more or less obesogenic via local zoning laws. All these smaller elements can form a vital domino effect for health and wellbeing. The commission calls for looking at the intersections of the pandemics and then seeking out the win-win or win-win-win (addressing two or three of the pandemics) which calls for new ways to work together. The need for long term thinking is challenged by the short term nature of local or national political cycles.
Positively impacting health and wellbeing worldwide will take thoughtful partnership and a long-term planning mindset. We see the negative impacts of displacement due to climate change- Syria is a good example, the current number of refugees seeking new countries to live in is having significant effects on nations and health systems addressing the influx of new citizens. If we don’t address, this is a holistic way we will miss an opportunity to impact future generations and ensure the health of the planet and its occupants.
Thanks for reading – Trina
(Opinions are my own)
Lancet Commission report on Global Syndemic