Governing the food systems

Food systems are changing, and changing at an enormous speed. Along with the change in dietary patterns and lifestyles, our community disease profile is also changing. Instead of the infectious diseases like cholera and TB, now the non-communicable ailments (NCDs) such cardiovascular diseases (CVDs), diabetes, hypertension, cancers, mental disorders and obesity are the main reasons behind unhealthy life, disabilities and death. Why is food or dietary pattern important in disease burden? The answer is simple: human beings are also chemical beings. What they eat interacts with of their body and mind in various complex ways. With this simple sensibility comes a great understanding that oil and fats, added sugars (e.g. sugary drinks) and salt are dietary risk factors in the increasing incidence and prevalence of NCDs.

In Pakistan, NCDs now cause more than 60% of deaths, and around 30% are attributed to CVDs and these deaths are higher than global average. Pakistan hosts the third largest population of people with diabetes in the world i.e. 33 million whereas 10 million more are pre-diabetic. Hypertension is also taking its toll with 43% of adults ageing 30-79 are carrying the disease, and, most importantly, not everyone is being treated with high-quality standard treatment regime for these diseases.

All this tells us a sad story of lives being lost prematurely i.e. before the age of 70; family financial losses due to inability to work and spending hard-earned money on treatments of avoidable diseases; and deaths at the time when one is thought to be the most productive, thereby stunting our GDP. This story calls for action — not only for some sort of awareness, but also for policy and administrative measures to build and strengthen a health security regime in the country.

While there is no one silver bullet to solve the problems of CVDs, high blood pressure, high blood glucose and high body mass index, there are certain policy measures and best policy practices which can be applied to control dietary risk factors for a majority of population. First and foremost, we propose and advocate for looking seriously into the prevalent state of affairs in food systems and its governance. One of the most important aspects is to ensure that food supply is safe to consume and is nutritious.

Looking at the supply of fats and vanaspati ghee, Pakistan encounters serious problems to deal with. In Pakistan, most of the street food and vanaspati ghee is replete with iTFAs (industrially produced trans fatty acids) which many medical researches have declared associated with NCDs. WHO recommends that there should be no more than 2% of iTFAs in any fat used in any food item. Pakistan is many moons away from implementing this best practice policy which has helped reduce CVDs in many countries such as Denmark. Countries like Saudi Arabia have even banned the production of vanaspati ghee to completely eradicate the menace from food supplies. Our foods, specially the highly processed, fast and frozen foods, have high quantities of added sugars and sodium, and our society is falling prey to these risky food supplies. Over and above, such foods are sold without proper front of product labelling (FOPL) and warning signs.

So, in addition to the need of having good quality accessible and affordable healthcare to everyone, there is a need to provide safe to consume food so that our health system does not break down due to the ever-increasing pressure of unwell and unhealthy population.

Last but not least, we propose and argue for modernising the system of food related governance. We need to build technical, human, infrastructure and legal-administrative capacity of various institutions such as Pakistan Standards and Quality Control Authority, PCSIR and Provincial Food Authorities, and look at the “new foods” part of public health concerns. It is hoped that by controlling dietary risk factors, Pakistan ensures a better health security regime for its citizens.

Published in The Express Tribune, January 11^th, 2024.

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