Need CHD prevention be puritanical?

Conference reports systems were being compared. It was the latter which was the most experimental. Chemicals are used, but not at the highest levels, and it is already apparent that a reduction in nitrogen levels on crops reduces disease, and that a simple crop rotation can significantly reduce herbicide usage. But integrated pest control makes no sense in isolation; any change affects the whole system, so pest control must be seen as part of a larger whole.

Surplus The dairy farmers present were not sure what they would do to meet their quotas. A farmer with high fixed costs will probably have to remain intensive, reduce herd size and plough up land for cereals. If his fixed costs are not so high, he could cut costs and output by reducing concentrate usage. Either way, the EEC grain surplus will increase! There was a feeling that grain quotas would have to come next. The other topic at the conference which will be of interest to readers of Food Policy was that of Food Quality, introduced by Dr Arthur Jone (Rowett Research Institute). The point of departure was the Report of the National Advisory Committee on Nutritional Education (the James Report). The evidence regarding the relationship between diet and the incidence of diseases, especially coronary heart disease (CHD) and certain forms of cancer, was briefly reviewed, including the recently published American study on the relationship between serum cholesterol levels and CHD incidence. RURAL was not concerning itself with the validity of the evidence but with the implications of the recommendations, which are in line with many other studies and becoming more and more widely accepted. The James Committee recommended a reduction in fat to 30% of dietary energy intake, a reduction in sugar and salt, and an increase in dietary fibre. It is clear that changes are already occurring in the market-place. Housewives are demanding leaner meat, and sales of skimmed and semi-skimmed milk, more generally available now,

FOOD POLICY August 1984

are increasing. What does this mean for the farmer? In cattle, as body weight increases, fat content goes up and protein, as a proportion of total weight, does down. But if cattle are slaughtered at a lower age, there is less total protein, so more animals would be needed to produce the same amount of actual meat. Steers have less fat than heifers, and bulls less fat than steers. There are, therefore, obvious possibilities in changing beef production to produce less fat, but the present ‘fatstock’ grading system would need to be changed. Similarly, the Milk Marketing Board’s payment for milk is partly based on fat content and so is encouraging fat production, yet reduction of the fat content of milk by 1.5% would achieve 40% of the fat reduction in our diet that has been recommended. As Mr Wheelock of Bradford University said, the present system of prices, subsidies and grading means that the signals from the market-place are not being communi-

cated to the producers. There is a need for better labelling of processed foods (which other countries already have) to give nutritional compositions, and farmers ned to be better informed on issues of food and nutrition. There may be a shift away from animal products, and large retailers are recognizing the increasing health food market. For farmers and growers there is scope to produce more fruit, vegetables and whole grains. The likely changes in our dietary habits will, in the EEC at least, exacerbate the problem of food surpluses. Thus, economic forces are at last coming to the aid of those who wish for a less intensive and, in the long run, more sustainable form of agriculture. Research into lower input systems will also be much more relevant to the needs of developing countries in so many of which real food shortages continue. Tilo Ulbricht London, UK

Need CHD prevention be puritanical? Conference on Action to Prevent Coronary Heart Disease, sponsored by the British Cardiac Society, the Coronary Prevention Group, the Department of Health and Social Security (DHSS), and the Health Education Council, London, UK, 17 April 1984 In his introduction Dr E.D. Acheson, the Chief Medical Officer of DHSS, said that coronary heart disease (CHD) was one of the most pressing public health problems of our time. Why are the death rates from this disease in the UK so high? Since 1968 there has been a 25% decline in the USA and of 40% in Australia, but not in the UK. The decline in the USA has been general, independent of sex, race and age, and has been associated with a positive approach to individual health and lifestyle, in relation to diet, smoking and exercise. In the UK it is now the lower social classes (classes 4 and 5) which are the most affected by CHD. The typical UK diet is too rich in saturated fat. DHSS and the Ministry of Agriculture, Fisheries and Food

(MAFF) are considering labelling foods with respect to fact content, so that consumers can make informed choices. There needs to be positive collaboration with the food and agriculture industries. Professor Geoffrey Rose introduced the Report Coronary Heart Disease Prevention - Plans for Action, which is based on an interdisciplinary workshop conference held at Canterbury in September 1983.’ People from 18 different skill areas, such as the health service, government, the agriculture and food industries, Community Health Councils, and economists took part. Rose pointed out that the scale of mortality and morbidity from CHD exceeds those from past scourges like cholera and the plague: one-third of

261

Conference

reports

men and one-quarter of women in the UK die from it, and many suffer severe disease and disability. Pathological surveys show that atherosclerosis (the precursor of CHD) is present in over 90% of the population; other diseases affect only a minority. Surgical and medical treatment is irrelevant to most, as is always the case with a mass disease. There needs to be prevention. The main underlying causes which have been identified are diet, smoking, obesity and lack of exercise. The average diet in the UK is too fatty. This means that most of us are at fault -which we find difficult to accept. The change which is necessary will come about gradually, and the economy can adapt, as it is already doing elsewhere. Rose asked: who should do what? He gave us his answers: there needs to be a positive government policy; changes in food supply and information; and, an informed public accepting responsibility for its own health.

Smoking Professor Philip James, who spoke on ‘National health policy and planning and food and agricultural policy’, and Dr J. Catford, who spoke on ‘Regional and district health policy and planning, primary health care and education’, both began with the subject of smoking. James wants tobacconists to be licensed, so that their licences can be removed if they sell cigarettes to children, and Catford wants to ban all cigarette advertising, and promotion of sport by tobacco companies. This emphasis on smoking in relation to CHD seems misplaced. Japan has the highest cigarette consumption in the world, the Japanese have high blood pressure (from their high-salt diet), and yet the incidence of CHD is the lowest of any developed country and life expectancy is the highest in the world. But the CHD incidence amongst people of Japanese origin in the USA who have adopted an American diet is like that of other Americans. This shows that the low incidence of CHD in Japan is not due to genetic factors, and indicates that diet is the primary cause. Other factors are secondary.

262

James went on to speak about the UK’s fatty diet. Milk and butter contribute one-third of the saturated fat consumed, so reduction of the fat content of milk should be encouraged. It is also clear that the production of slaughter classes of beef animals does not match consumer demand: we produce beef that is too fat. Should there not be a Standing Committee on the Economic Implications of Health, reporting to DHSS? A minor but staggering statistic was that 88% of the salt in the UK diet comes from processed food.

Bureaucracy Catford’s proposals were: adult health coordinators appointed on an area basis; regular monitoring of the population for smoking, obesity, exercise, blood pressure and alcohol consumption (why not diet?); more health visitors; district ‘facilitator/liaison persons’ to be appointed; regional health promotion teams to be set up, to appoint regional health promotion officers; district heart disease prevention teams to be set up; and community development workers and primary

care team facilitators appointed. I suspect that many fervently hope that no such puritanical bureaucracy will ever be set up. The evidence that action is needed is convincing, and a more positive approach from government, coming from DHSS and MAFF working together, is necessary. More accurate and informative labelling of foods, which already exists in other countries, should be introduced in the UK. As the market changes (and it is already changing) the food and agriculture industries will adapt. Nothing dramatic is going to happen, nothing drastic is going to change overnight. A gradual change will enable consumers to adapt their lifestyles, and industry to adapt its production and food products. Things are beginning to move in the right direction, and what is needed is better coordination of policies (especially of health in relation to nutrition and agriculture) and gentle and sustained encouragement, rather than a bureaucratic approach. Tilo Ulbricht London, UK ‘Published by Pitman, London, 1984.

The hunger lobby strikes again International Conference ‘For Millions of Living Persons Now, in 1984 - Against Extermination and the Holocaust of Poverty, Hunger and War; the Poor Can’t Eat Theories’, Rome, 17-19 April 1984

Remembering the description of a camel as a horse designed by a committee, here we have the winning conference title in the camel-of-theyear awards. There was also an alternative version, which ran, ‘The poor can’t eat theories; extermination by hunger. A new strategy of life.’ But don’t misunderstand: this was not a private meeting of the loony fringe. They had the President and Prime Minister of Italy, they had Brad Morse from UNDP, Jim Grant from UNICEF, Prince Poniatowsky of the European Parliament and RenC Dumont in his red sweater, to name but a few. Once over the hump of the conference title, however, it’s still not much easier to know what to say about

the meeting itself. One half of the participants, it seemed, was stamping on the accelerator trying to gun their creaky bureaucratic machines into a headlong drive against hunger, while the other half was heaving on the handbrake and mouthing silent imprecations against the crazy fools whose precipitate good intentions would confound us all. The meeting was largely masterminded by Food and Disarmament International, which is the current pseudonym of Jean Fabre, a man of single-minded commitment and who matches his radical credentials with an impressive knack for playing the establishment system. After getting to

FOOD POLICY August

198yI