Noncommunicable diseases (NCDs), the leading cause of global death and disability, claim 41 million lives annually, with a staggering 71% of these deaths linked to conditions like cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Predominantly affecting low- and middle-income countries, where 31.4 million of such deaths occur, NCDs are increasingly tied to younger populations, with 17 million deaths occurring before the age of 70. Unhealthy diets and lack of physical activity significantly contribute to this burden, manifesting as metabolic risk factors like raised blood pressure, increased blood glucose, elevated blood lipids, and obesity, which can precipitate cardiovascular diseases—the foremost cause of premature NCD deaths.
Climate Health Review talked to Dr Mahfuzar Rahman, Country Director, Bangladesh at Pure Earth to understand the intersection between food and NCDs.
Dr Rahman has a long experience in global health and nutrition. He was ranked among the top 2% of scientists in the world by Stanford University, USA. While most of his work has been related to low-income settings, Dr Rahman has also been involved in research with the Global Burden of Diseases in Seattle and Imperial College, London for many years.
Q: Dr Rahman can you tell us how governments and the public health community can create a healthier food environment to have a positive impact on NCDs and climate change?
A: Malnutrition and unhealthy diets are important risk factors for NCDs and there is an urgent need to have a clear-cut policy on what and how food is produced, marketed, and consumed.
And it’s for the governments and the public health community to translate global NCD prevention recommendations into concrete measurable indicators that address the priority challenges with respect to creating healthier food environments. Extreme weather (heat or rain) can cause a significant burden on mental health too. This will make it easier for companies to develop clear and meaningful policies and will facilitate effective monitoring and benchmarking of performance. In addition, systems for monitoring the healthiness of food environments, as well as company policies and actions in the area need to be strengthened. In the absence of progress and greater industry action, governments need to consider stronger regulatory action and increased regulatory capacity. Encouraging a shift towards more plant-based diets can reduce the risk of NCDs, such as cardiovascular diseases and diabetes, and also decrease greenhouse gas emissions from the agriculture sector. Public health campaigns and educational programs can raise awareness about the health and environmental benefits of consuming more fruits, vegetables, nuts, and whole grains to minimize NCD burdens.
Q: What radical transformation in food systems is required to prevent diet-related NCDs?
A: Carb diets, malnutrition in all its forms, and NCDs are closely linked. Real progress to prevent diet-related NCDs across the life cycle requires radical food systems transformation so that nutritious, safe, affordable, and sustainable diets are accessible to all. But strong emphasis should be on curbing processed/junk sugary and fatty foods as well as increasing protein intake. Food systems and the infrastructure on which they depend must be restructured. Reforms to the supply side of food systems to improve the availability.
Food, agriculture, and trade policies—which were often originally devised to ensure quantity rather than quality of food—must remove incentives to produce less healthy foods and create incentives to produce diverse and nutritious foods using sustainable practices.
Urban Farming Initiatives: Supporting urban agriculture projects can help cities become more self-sustaining in terms of food production and reduce the carbon footprint associated with transporting food items. This also promotes the availability of fresh and nutritious food.
Furthermore, encouraging practices such as organic farming, agroforestry, and conservation agriculture can lead to more sustainable food systems. These practices help preserve the environment, improve soil health, and reduce the use of harmful chemicals.
Q: What structural actions are required to improve the food environment to control NCDs?
A: High taxation on the mainstream companies, and small, locally operated producers need to be brought under regulations. But policy indicators like food composition and proper food labelling, need to be highlighted.
Governments should bring policies to restrict exposure and power of promotion of unhealthy foods to or for children through broadcast media, and ensure unhealthy foods are not commercially promoted to or for children in settings where children gather (e.g. preschools, schools, sports, and cultural events) and restrict the marketing of breastmilk substitutes.
Taxes or levies on unhealthy foods must be in place and the retail prices of these foods should be increased by at least 10% to discourage unhealthy food choices where possible, and these taxes are reinvested to improve population health. Firstly, implementing clear and informative food labeling can help consumers make healthier and more environmentally friendly choices. Labels that indicate low sugar, low sodium, whole grain, and organic or sustainably sourced can guide better decisions. Additionally, developing strategies to reduce food waste at all levels of the food supply chain can significantly impact climate change and resource use. This includes improving storage facilities, and transportation methods, and promoting the use of “ugly” vegetables and fruits that are perfectly edible but often discarded because of their appearance.
Q: Do you think it’s possible we can eliminate malnutrition in all its forms and prevent diet-related NCDs?
A: Dietary diversification and food fortification, as well as nutrition education, public health and food safety measures, and finally supplementation and targeting the ultra-poor are some strategies to eliminate malnutrition and prevent diet-related NCDs. Implementing taxes on sugar-sweetened beverages and junk food, while subsidizing healthier options, can financially encourage consumers to make healthier choices.
Engaging communities in policymaking and the implementation of local food projects can increase the acceptance and effectiveness of initiatives. Community gardens, local farmers’ markets, and educational workshops can empower individuals to make informed food choices.
Q: Floating farming in Bangladesh is an innovative method for food security. Has it helped reduce NCDs and climate change?
A: An ecosystem-based action has provided both human well-being and biodiversity benefits. This actually helps secure food security as well as cope with NCDs. Since Bangladesh’s floating agriculture depends on nature, wetland flood water, and aquatic plants, this system may be adopted in LMIC to minimize the malnutrition burden.
Floating farming can increase access to fresh produce. Floating farms allow communities, especially those in flood-prone areas, to grow vegetables and fruits even during floods. This access to fresh, nutrient-rich produce can help improve diet quality and reduce the prevalence of NCDs such as diabetes, heart disease, and obesity, which are often exacerbated by poor diets. Promotion of healthy eating by providing a steady supply of fresh produce, and floating farming can encourage a shift toward diets higher in vegetables and fruits—key components in preventing NCDs.
Q: Can you talk about breastfeeding? How can we protect and promote optimal breastfeeding and complementary feeding to reduce the risk of developing overweight and diet-related NCDs later in life?
Ans: Antenatal education for breastfeeding practice, educate all prospective mothers about the health benefits of breastfeeding as well as the risks associated with formula, banning advertising of breastmilk substitutes and behavioral change interventions that include promotion of breastfeeding, appropriate complementary feeding practices. Restricting the advertising of high-calorie, nutrient-poor foods, especially those targeting children and vulnerable populations, can reduce the prevalence of obesity and other diet-related NCDs.
