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Global health problems call for solutions on a national and international scale.

HEALTH problems such as diabetes, obesity and heart disease are global issues that need to be tackled by societies as a whole, says Colin Tukuitonga, who has recently returned from a three-year term with the World Health Organisation (WHO).

Colin Tukuitonga

Colin, a former Director of Public Health in New Zealand (now associate Professor of Public Health, Head of Department, Pacific Health), was based in Geneva, Switzerland, and responsible for the WHO programmes on the surveillance and prevention of chronic diseases such as diabetes, heart disease, some cancers and obesity. He was involved in developing global policies and interventions to help the 196 member countries of the WHO tackle the spread of these diseases, particularly in children.

The problem is too large and complex to be addressed just by health authorities, says Colin.

“The problem is far bigger than that. The traditional notion that the health sector protects and promotes health is just not going to be enough. Society as a whole has to take action, in tandem with global bodies such as the WHO.”

The WHO’s global strategy on diet and physical activity contains recommendations for groups at many levels – for governments, the private sector, non-governmental organisations, as well as academic and research organisations.

In many parts of the world it may be difficult to get medicines through to remote communities but I tell you what, Coca-Cola always gets through.

“There is a recognition that obesity (and related issues) is a multi-layered, multi-sector problem and just working within the health sector is not going to do anything,” says Colin.

“For example, food policy and availability in many countries is determined by trade imperatives and obligations, by economic development and by the policies of agriculture and fisheries ministries. In other words, a lot of it is beyond the immediate brief of a ministry of health.”
Agricultural policies in many countries are really about agriculture production for commercial purposes, says Colin. The focus is on business not health.

“The WHO’s recommendation of 400 grams of fruit and vegetables per person per day is not being met in most countries. A major challenge therefore is to influence the agriculture sector to place less reliance on policies which increase the production of meat and dairy and more on the production of fruit and vegetables, as well as fish and aquaculture, for local consumption. It’s a complex process to influence these things and it needs to be dealt with even-handedly, mindful of WTO obligations.”

The global marketing and consumption of high-fat, high-salt, high-sugar processed foods is also having a huge impact on the health of the world’s population, both in developing and developed countries, says Colin. Increasingly in developing countries, processed foods are more affordable than traditional crops so people change their dietary habits to buy what they can afford.

“In many parts of the world it may be difficult to get medicines through to remote communities but I tell you what, Coca-Cola always gets through. Therein lies the challenge. The products which are being promoted to the far corners of the globe are high in fat, sugar and salt, not the products that are recommended for a good diet. We have a long way to go to catch up with these companies that are so adept at marketing and distribution.”

The WHO has an important role to play in exerting influence over the global manufacturers of these food and drink products, says Colin. Increasingly these products are being manufactured by fewer and fewer multinationals so the policies on the contents of the products being sold at the local franchise operation are being determined elsewhere in the world.

“My experience is that multinationals are worried about their reputation and so are responsive to external pressure. In many instances they have reduced the sugar and salt contents of their products. They are taking action but generally speaking there is a long way to go.”

Right now there are more obese and overweight people in the world than starving people.

Obesity was once regarded as the problem of the rich and affluent but is now the problem of the poor also, says Colin.

“The knowledge and the ability to choose healthy products is more difficult for people at a lower socio-economic level. Opportunities for physical activity are more limited because often their environment is not safe and they live in a crowded apartment block. The whole environment is conducive to producing obesity.”

Colin says that with the possible exception of sub-Saharan Africa, obesity is increasing in all areas of the world. Worryingly, its rate of increase is even more rapid in developing countries and the trend is set to continue. We have created a way of life – with the mass production of energy-dense food and the sharp decline in physical activity – that poses a serious threat to our health.

“Right now there are more obese and overweight people in the world than starving people,” says Colin.

The size of the problem demands bold and decisive action on a scale we haven’t seen before, he says. Initiatives being considered include banning of advertising of undesirable products, particularly to children, introducing regulations to enable a more physically active population and developing transport options which encourage cycling and walking.

“Society as a whole has to take action,” says Colin. “It’s not enough to leave it as a matter of individual choice. That would be a convenient option but those who work in public health know that the wider environment has to be modified. You need both. Preaching to the individual who can’t afford to choose the healthier but costlier items on the shelf, who is unable to exercise, is not going to do anything. You have to work on the environment as well.

“There has never been a successful public health programme that has come about simply because you educate the population. New Zealand has launched some good health-promotion campaigns in relation to healthy eating and being active, but it is still very inadequate.”

Colin believes leadership needs to come from the level of head of state. Health is everybody’s business so that means a contribution from the health sector, the education sector, urban transport, agriculture, the private sector, local government and non-government sector.

“The sooner the world wakes up to the fact that health is everybody’s business, particularly in relation to these common problems, the better off we all will be.”

Colin has returned to New Zealand to take up a position as the Associate Professor of Public Health at Auckland University. He is responsible for the International Public Health programme and also has a role in looking after the Pacific section in the School of Population Health.

“I’m very happy to be back. I don’t think New Zealanders appreciate how good healthcare is in New Zealand. When you visit other countries you appreciate what we have here. Things could always be better of course but the international experience changes your perspective.”

Colin says he really enjoyed the chance to gain international experience at the WHO and the opportunity to work in such a multicultural environment.

“It’s harder to see the impact you are making when you work at that level but I have no doubt the WHO is producing benefits for global public health. The encouraging thing is that developing countries in particular regard WHO advice as credible and practical, and generally follow it.”