A case for healthy food environments
Governments are obligated to intervene in the prevention and control of nutrition-related non-communicable diseases (NR-NCDs) through the promotion of healthy food environments. The Constitution of Kenya, in particular, recognizes population rights to health and food. This forms a strong basis for the use of a combination of population health evidence and human-rights-based approaches to progress public health and rights.
From a life-course perspective, it is critical that the environments in which individuals are born, grow, live and age are shaped with consideration of their right to health. This is important as evidence shows that adverse conditions, particularly in childhood, can create changes in body function which could be detrimental to health later in life. There is a need for greater prioritization of children’s rights, the right to health, and the right to food in all actions by state and non-state actors in light of an increase in NR-NCDs cases and the rising prevalence of overweight and obesity. According to the Ministry of Health, this change in disease profile can be attributed to shifts in dietary patterns and increasing availability, affordability, and marketing of processed foods.
The good news is that Kenya’s constitution recognizes the aforementioned rights. This not only obligates the government to fulfill the realization of the rights of all individuals within its jurisdiction, but it also provides an avenue for us, the right-holders, to exert our influence and seek redress when our rights are not being met. Regarding the food environment, governments, private sector actors, and the public should act in “the best interest of the child” and consider the right to health and nutrition before engaging in activities that could affect the physical and social environments. This, however, is easier said than done, particularly when combating commercial determinants of health.
Although Kenya has realized some successes in the regulation of tobacco and alcohol, there had been significant pushback in the formulation and implementation of the marketing and sale regulations. While Kenya does have some policies regulating the food environment, the country lags in the adaptation of the World Health Organization’s recommendations for the reduction of NCD risk factors through the creation of health-promoting food environments. This could have a profound impact on the success of Kenya’s Health Policy (2014-2030) goal of halting and reversing the burden of NCDs, majority of which are attributed to unhealthy diets. Namely, the policy recommendations include front-of-pack-nutrition labeling (FOPNL), restrictions on child-directed food and non-alcoholic beverage marketing, and fiscal policies such as sugar-sweetened beverage taxation. To move the process forward, it is important to understand the factors which hinder or facilitate policy development and implementation.
The recent Global RECAP project explored the barriers and facilitators to the adaptation and implementation of the aforementioned policies from the perspective of policy and decisionmakers in Kenya. Based on the study findings, a glaring challenge to the adaptation of the policy recommendations is the prioritization of commercial interests over the human rights of the population. Why is this so? Well, it was explained that the food industry, also known as “Big Food”, has been seen to leverage their bargaining power over policy and decision makers either through their contribution to the economy through taxes, or conflicts of interest with policymakers who have commercial interests. Even if we were to imagine a world devoid of these conflicts of interest, Big Food reportedly cites industry rights and trade agreements as platforms to seek legal action against their regulation. Furthermore, government intervention may be perceived as “paternalistic”, violating the rights of industry and not recognizing the role of personal responsibility in decision-making by individuals. As there are enabling legal frameworks for the protection of the right to health, food, etc., to achieve what the Constitution states that “every person has the right … to be free from hunger and to have adequate food of acceptable quality”, then one of our main challenges is the political will to adopt and implement policies for healthier food environments.
How can we increase the political acceptability of food environment policies and regulations?
According to the study participants, the collection and incorporation of evidence into the policy-making processes to support the prioritization of public health concerns over commercial interests is an essential step. While concerns surrounding the burden on NCDs and the commercial determinants of health are novel for us in sub-Saharan Africa, we can shape local efforts against international evidence. Of course, this should be done considering nuanced contextual differences in formulating potential policies. Additionally, the importance of increased capacity building on healthy diets and how diets are linked to ill health, and human-rights-based approaches to policy and decision-makers in government, civil society, and the public was stressed. By empowering policy and decision-makers on this, they were said to be better able to identify what is legally feasible regarding health decision-making and then claim population rights over commercial interests for the well-being of our nation.
Furthermore, the population will be informed about healthy diets and their rights for improved uptake of the interventions and their increased ability to seek legal redress in case of violations. So yes, government actions for healthier food environments are legally feasible. We ought to work on creating more awareness and achieving political will to increase the likelihood of adopting these policy interventions.
This article was written by Veronica Ojiambo, a Research Officer at the African Population and Health Research Center.