Professor Sharon Friel is Professor of Health Equity and Director of the Menzies Centre for Health Governance at the School of Regulation and Global Governance (RegNet). She was Director of RegNet from 2014-2019. Sharon is a Fellow of the Australian Academy of Social Sciences.
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This blog was originally published with The Australian Prevention Partnership Centre on 13 Feburary 2019.
The three greatest threats to the planet are obesity, undernutrition and climate change – and they are inextricably linked, according to the Lancet Commission on Obesity. Professor Sharon Friel was one of four Prevention Centre researchers on the team of 26 Commissioners and 17 Fellows from 14 countries whose report was published last month. Here, she suggests what we, as individual researchers and policy makers, can do to address these pandemics.
Three years ago, I sat together with the other Commissioners of the Lancet Commission on Obesity to discuss what we could do to drive action globally on malnutrition in all its forms – the world’s leading cause of poor health.
As people brought to the table their experiences from Australia and New Zealand, Europe, Asia and the Americas, it became very clear that we could not address obesity, undernutrition and other dietary risks without also taking climate change into account.
Nutrition and the climate are intimately bound. The changing health of the planet affects our ability to produce and access healthy food, while at the same time the global food system, from production through to consumption, is making a significant contribution to carbon emissions.
Through a series of group model building sessions, evidence reviews, face-to-face meetings and consultation workshops, we developed the concept of the Global Syndemic. This refers to the three pandemics of obesity, undernutrition and climate change that co-occur, interact with each other and have common drivers.
This three-part threat to human survival has similar physical, psychological and social consequences, and is being driven by food, agriculture, land use, transportation and urban design systems.
Our report offers nine recommendations and more than 20 double-duty or triple-duty actions – actions that simultaneously act on two or all three of the pandemics and that will have major beneficial effects on planetary health.
Among our recommendations are the need to strengthen the governance arrangements of these systems at the international, national and municipal levels; to reduce the influence of commercial interests in the public policy development process; to strengthen accountability systems; and to create sustainable and health-promoting business models for the 21st century. Of course, we need research to build the evidence base around Global Syndemic determinants and actions.
We looked at examples from around the world to help us understand how to move the Global Syndemic agenda forward. As the introduction of a tax on sugar sweetened beverages in Mexico and food regulations in Chile have shown, we need government and civil society to work together to enable courageous action in the face of lobbying from big industry.
How can we as researchers and policy makers take action to address the Global Syndemic? Here, I offer my own interpretation of what the Lancet Commission’s findings mean for us.
1. Focus on policy coherence
As my own work and that of my colleagues at the Prevention Centre has shown, we cannot address these global and national challenges by working in disciplinary or sectoral silos. We need to proactively bring together actors from different domains – from health and non-health, education, agriculture and the environment – to think collectively about ways to address the drivers of the Global Syndemic – there are many co-benefits in doing so.
As a researcher, that means avoiding researching these policy issues in isolation. The key is to find coherent actions between different policy domains.
2. Look upstream
We know there is policy inertia around tackling the systemic drivers of the Global Syndemic. Our policy gaze has drifted to the responsibility of the individual – but actually, we could do a lot about climate change and obesity if we were to address some of the underlying food system problems that strongly influence individual choice.
That means we should be aware of major industry tactics that prevent strong regulation and government action. And we need much more upstream monitoring to increase the accountability of major actors for coordinated actions – something we at the Prevention Centre are trying to do, for example, in the area of food and nutrition.
3. Take a systems approach
We need to think about how interventions will work in isolation or in combination, how policies can create virtuous feedback loops to produce better health and environmental outcomes, and how they can also lead to unintended consequences. Using system dynamics approaches and tools will help us see the system and understand key points for intervention.
As our work at the Lancet Commission has shown, systemic change is possible and is happening around the world. It requires coordination, collaboration, strategizing and courageous leadership. It is up to us as individuals to create opportunities for that to occur.
4. Always focus on equity
The inequities that are inherent in our current policy environment feed through to inequities in health outcomes. In Australia and throughout the world, it is the disadvantaged who are the most vulnerable to obesity and undernutrition, and who are the least able to adapt to climate change.
In my new book, Climate Change and the People’s Health, I describe what I call “consumptagenic systems” – excess production and consumption that I think are the common drivers of climate change and health inequities. We need to redress the power imbalance, and design policy in such a way that we consider who will benefit and who will lose.
Hope for the future
Addressing these big issues will take courage, progressiveness and engagement. But it is time to move from denial and inertia toward action.
I am hopeful. Forging synergies across the domains of health, equity and the environment will flow on to positive benefits for populations and the planet itself.