The Sugar Season

The holiday season that is now upon us is a time for festivity, and usually of overeating. But the rampant consumption of sugar that marks this time of year is nothing to celebrate.

In fact, this seasonal upsurge in sugar consumption is just part of a huge transition in world health that is now underway. Many countries, especially developing countries, are facing the consequences of huge changes in lifestyle: modifications in diet, lower levels of physical activity, and increased tobacco use.

These changes are determined, to a large extent, by the globalization and expansion of food markets, and by ever-greater levels of urbanization. Both of these factors incite sedentary behavior at home and at work, as well as profound alterations in dietary habits.

So it should be no surprise that noncommunicable diseases (NCD's), including cardiovascular diseases (CVD's), obesity, diabetes and cancer, now kill roughly 33 million people around the world each year, and cause almost 60% of total deaths. Indeed, they account for almost half the global burden of disease.

By 2020, that contribution is expected to rise to 73% of all deaths and 60% of the global burden of disease. Moreover, more than 60% these deaths occur in the developing world, and here NCD's increasingly appear in younger age groups, which can have huge implications for how productive a country's workers are.

Recent data from China reflect the extent of the problem. In China's rural areas, with more than 800 million people, NDC's account for more than 80% of deaths.

Many countries are now afflicted by a double burden of diseases. Countries that still struggle with malnutrition and illnesses like malaria, tuberculosis, and HIV/AIDS, now must contend with an explosion of CVD's, diabetes, and obesity, as well as soaring rates of high blood pressure and high blood cholesterol.

Indeed, five of the 10 leading causes of death worldwide are related to diet and physical activity: high blood pressure, high cholesterol, low intake of fruit and vegetables, high body mass index, and insufficient exercise. Clearly, effective strategies to tackle the NCD burden require a critical examination of what people are eating and their levels of physical activity.

The World Health Organization, together with a group of international experts, has developed a global strategy on diet, physical activity, and health over a period of 18 months through an extensive series of consultations in more than 80 countries, and with the input of United Nations bodies, civic groups, and food producers. One of the strategy's key conclusions is that reducing the burden of NCD's requires a multi-sectoral approach. Like a toolbox, the strategy provides WHO members with a comprehensive range of policy options from which to choose.

Governments can act. Transport ministries should provide safe roads so that children can bike to school. Finance ministers could tax unhealthy food and subsidize healthy food. Education ministers should demand healthy school meals.

Many countries are already developing their own national strategies. Most of what WHO is recommending has been endorsed by public health officials for many years. But we face a global problem, with many international stakeholders, and this requires an urgent and worldwide response.

Of course, there is considerable debate about what precisely makes for a healthy diet. This debate is both welcome and to be expected; improving diet and finding ways to increase physical activity is a complex issue. Moreover. there will always be groups with their own interests, using arguments that we do not have sufficient evidence to act. But there has been no challenge to the strategy's recommendations from the global scientific or public health community.

The strongest critique has come from sugar associations, who claim that the upper limit of 10% on caloric intake from sugar is not based upon scientific evidence. However, more than twenty national and international reports from around the world by scientific bodies governing dietary recommendations set similar or lower targets for sugar intake.

The growing NCD and CVD burden is a time bomb for world health. The implementation of the WHO's strategy could lead to one of the largest-ever positive shifts in human health, putting populations throughout the world on pathways to lifelong and sustained improvements in well-being.