CASE STUDIES ON OBESITY PREVENTION AND CONTROL THROUGH TRADE

1. CASE STUDIES ON OBESITY PREVENTION AND CONTROL THROUGH TRADE Vincent J. Atkins www.crnm.org

2. Slide Title • Much research has focused on the link between obesity and trade liberalization and on the use of fiscal measures, mainly taxes, in the fight against obesity. • Much more limited work has been undertaken on the use of trade policy in the prevention and control of childhood obesity.

3. Slide Title • The limited research undertaken, however, seems to suggest that trade has had an important impact on the large shifts in diet and activity patterns among countries which have given rise to the increased incidence of obesity. • This presentation reviews some of the case studies on the links between trade and the nutrition transition and the lessons for obesity prevention and control.

4. One of the early studies on the implications for trade policy for diet and health undertaken by Anne Marie Thow and CorrinaHawkes in 2009 document changes in tariffs and non-tariff measures in Central American countries and compared them with time series graphs of import, production and food availability data to show the outcome of changes in trade policy in relation to food imports and food availability.

5. The study found that changes in trade policy in Central America directly affected food imports and availability in three ways (1) the lowering of trade barriers promoted availability by facilitating higher imports of a wide range of foods (2) trade liberalisation affected availability by promoting domestic meat production and (3) reductions in barriers to investments appeared to be critical to expansion of processed food markets.

6. Lessons for Childhood Obesity Prevention and Control • Trade policies, and trade liberalisation, in particular have implications for food availability and health in the Region and play an important part in the ‘nutrition transition’ associated with rising rates of obesity. • Preventive health measures, including measures to prevent or control obesity need to take account of the impact of trade liberalisation on diets. Country specific studies of these impacts may be necessary.

7. A second study undertaken in Mexico by the Institute for Agriculture and Trade policy (IATP) in 2012 examined the impact of US farm and trade policy on the Mexican food environment. • To isolate the impact of NAFTA in changing Mexico’s food environment the study plotted the flow of several key products between the US and Mexico over the period 1994 – 2008 and compared this to historical trade flows.

8. The study found that directly and indirectly US exports of corn, soybeans, sugar, snack foods and meat products into Mexico increased significantly in the period after NAFTA. • The study also found out that US exports of these products was an important way in which US agriculture and trade policy influences Mexico’s food system.

9. Specifically, the study observed that NAFTA has contributed to the increased availability of soft drinks, refined and processed foods, meat and dairy products derived from cheap, imported commodity grains as well as the increased investments by US-based companies that manufacture food and drinks for sale in Mexico

10. In addition, because of significant US agri-business investments in Mexico across the full spectrum of Mexico’s food supply chain the Mexican food system increasingly looks like the industrialized food system of the US.

11. While it is not whether increasing obesity rates in Mexico is mainly a function of trade policy (as opposed to rising prosperity) the study noted that at a minimum trade speeds up the rate of the transition in nutrition. • The study also observes that increased consumption of obesogenic foods in Mexico is a trend among all socioeconomic groups and is not restricted to the more affluent groups.

12. Lessons for Childhood Obesity Prevention • National strategies to address childhood obesity prevention and control must address trade policies to ensure that these address public health and nutrition goals. • Some recent bilateral trade agreements, such as the US-Peru Trade Agreement, included limited exceptions for public health, safety and environment measures which would reduce the impact of trade liberalisation objectives.

13. Similar provisions in the trade policy of other countries can help to increase their control over the use of public policies to address concerns such as childhood obesity, without the threat of trade or investment disputes. • The IATP study suggests that trade policymakers ought to seek routinely the expertise and involvement of the public health community in the formation of these policies.

14. Childhood obesity impact assessment could also be one aspect of the health impact assessment of trade policies which countries undertake.

15. Anne Marie Thow and Wendy Snowdon examined the diet and nutrition transition in the pacific in the context of concurrent changes to trade policy and eventual trade liberalisation. • The study found out that in the recent past there was a dramatic dietary change in the Pacific from a healthful traditional diet to a ‘modern’ diet associated with high rates of chronic disorder, including childhood obesity.

16. The study observed that trade was clearly one of the key drivers of the dietary change and proposed that further exploration of options for healthy trade policy could be part of the solution in creating a healthy food environment. • Like the previous studies the research by Thow and Snowden points to the need for public health policies to be taken into account when formulating trade policies. This applies equally to measures aimed at addressing childhood obesity.

17. Phillip James and others examined whether food imports contributed to changing dietary patterns in Thailand and what strategic changes in trade and domestic policies were required to address the impact of food imports on the Thai diet. • The study observed that the three dominant deleterious changes in Thailand's food supply (increases in sugar, total fat and saturated fatty acid intakes) were not related primarily to imports.

18. As such, trade restrictive measures would have minimal impact in circumstances where the root cause of the nutrition transition lies in domestic sources. • The study also noted that there was limited scope for the use of domestic food regulations and pointed to a number of existing regulations which sought to address food related public health concerns.

19. The recommendation made by the study was the development of a system to classify foods on the basis of their potential health impact. • It was proposed that the system of nutrition profiling could be applied to both imported and domestic foods, using internationally recognised criteria for such profiling.

20. The results of the various studies examined indicate that there is no unique solution to addressing the prevention and control of obesity and that several factors including economic and cultural factors will determine the precise measures which should be used. • It is also evident that trade measures cannot be used in isolation of other policy measures including educational, social and environmental policies.