04 Apr 2010

DIHAD 2010

Your Excellencies,

Distinguished Guests,

Ladies and Gentlemen,

The biggest global health challenges that we will face tomorrow are the ones we are creating today.

Globalization, population growth, and climate change -- all man-made -- will have significant impacts on health. I am sure they will be discussed in detail by speakers in the coming days here at DIHAD.

The man-made challenge I would like to focus on this morning is how we manage our global food supply. When it comes to food, we live in a world scarred byboth want and excess -- and this presents enormous challenges to our health, our economies, and our future.

How can we overcome the flaws in the aid community that have kept us from making more progress?

Hungerand obesity are two sides of the same coin. Despite a sharp rise in obesity rates, undernutrition is still probably the greatest immediate threat to global health, because it plays such a large role in deaths among young children.

But the tsunami-like surge of overeating occurring worldwide is now creating a massive public health challenge in the form of non-communicable diseases like diabetes, stroke and heart disease.

In my role as a UN Messenger of Peace, the Secretary-General has asked me to focus on the Millennium Development Goals, especially reducing hunger and poverty by half by 2015. Simply put, we are not doing very well. In fact, we were not doing very well even before the food price crisis of 2007-2008 and the international financial difficulties we all now face.

The number of hungry people has climbed steadily since the mid 1990s largely unabated. At first the annual increase was only about 4 million people per year, but it has now skyrocketed to 50 million more a year. In 2009, the number of undernourished broke through the one billion mark for the first time in history. Ironically, another historic event occurred almost at the same time -- the number of overweight people worldwide surpassed the number of hungry.

Whether we are talking about too little, too much of the wrong kinds -- food is clearly a key challenge for public health.

There are some terrible inequities in how the world handles its food supply. In 2006, the World Food Programme produced, but never publicly released an interesting map. Dubbed the "Fat Map," it shows where the world's calories go with nations growing or shrinking on the map based on how many calories are available to their citizens. Depending on your perspective, it maps starving or overeating. But the maldistribution of food goes deeper than even the "Fat Map" implied. In certain regions of the developing world, for example, more than 300 million overweight people coexist with another 300 million who starve. Obesity is skyrocketing among young people. Surprisingly, some countries that still struggle with pockets of severe hunger are among those most challenged by rising obesity and the non-communicable diseases it causes.

So what do we do about the twin challenges of hunger and obesity?

We have to change the way we think about food and nutrition. To start, there is so much more research that needs to be done on the connections between diet and disease among the well fed and the hungry alike.

Fortunately, there is already growing medical awareness on how nutrients affect our mental and physical performance.It is hard to open a magazine without encountering an article or advertisement about how anti-oxidants help ward off chronic disease, folates promote reproductive health, or healthy foods lessen the chance of developing heart disease or Alzheimer's.The general public is keenly aware of how vitamins and minerals in their diets affect their overall health and well-being, pouring billions of dollars into supplements - that is far more money, by the way, than is spent globally on food aid for the poor.

So there is public awareness of the importance of nutrition, but it does not go far enough. We are all a bit myopic and tend to view nutrition through the lens of our own experience, especially in richer countries.

The idea of hunger as a threat to public health is increasingly hard for most of the modern world to grasp as they struggle to control expanding waistlines. Both Western and Arab donors focus on macroeconomic solutions to hunger and strictly medical solutions to illness. The traditional solution to hunger is simply to produce more food -- more wheat, maize or rice. It is not that simple. We need the right foods for the right people at the right times in their lives. Data collected before the increase in food prices showthat children in the poorest households in developingcountries are more than twice as likely to beunderweight as those in the richest households. Similarly, children living in rural areas are more likely tobe underweight than those living in cities and towns.

To deal with hunger effectively, we need to target our interventions better. Adequate nutrition is vital for building children'simmune systems and for their motor and cognitivedevelopment. Yet one child in four in thedeveloping regions is underweight. The consequencescan be fatal: more than one- third of child deathsworldwide are attributed to undernutrition. In thedeveloping world, the proportion of children under fiveyears of age who are underweight declined by onlyfive percentage points from 1990 to 2007 — from 31per cent to 26 per cent. This rate of progress is not enough to meet the MDG goal of reducing the prevalence of underweight by half — even without taking into account the recent impact of higher food prices and a global economic crisis.

Fortunately, on the hunger side of the coin, we are seeing some new and progressive thinking emerge.

Some organizations, principally MSF, have begun to promote high nutrient foods and medical intervention.Specialized foods like plumpynut, enhanced corn-soy blends and other new products are becoming effective tools in the struggle to prevent malnutrition before lasting damage is done -- pregnant and lactating women and children under two are the main targets for these interventions with new ready to eat foods. In the treatment of problems like wasting, MSFis promoting food as medicine -- a first line of defense against disease -- and that is an exciting development.

But, where will all this lead?

Well, one would hope to overall improvements in nutritional status and among health in the world's poor. That, in turn, would have a positive economic impact worldwide. Studies by FAO, the development banks and others have shown that malnutrition shaves anywhere from a half percent to 4 percent of economic growth in poorer countries. Some of the best analysis has been done in Latin America where an IADB study found that malnutrition was costing Central American countries and the Dominican Republic an amazing 6.4 billion dollars in lost economic output. The bottom line is that facing the challenge of malnutrition is not just a humanitarian imperative -- it will have significant economic payoffs for us all.

The other side of the coin -- overeating -- may well provide a tougher health challenge in the years ahead. There is no clear recipe of interventions that will hold this monster at bay. A major obstacle is the culture we have built up around food.

We sit by and watch each other overeat and discard food without a thought. Extravagant overindulgence is viewed as hospitality in many cultures and we often assume that being a good parent requires that we force feed those we love.

We pay dearly for this over-consumption. Recent calculations set obesity-related health spending just in the United States at 150 to 200 billion Dollars -- more than all foreign aid worldwide. The cost of extra medical care for the obese runs as high as 1400 dollars per person annually. Over 2 billion people do not earn that much in a year.

Half the Arab population is under the age of 25 and we are having our own explosion in obesity. In some countries in the region, one death out of every fourthat occurs between the ages of 35 and 64 is attributed to diabetes and indirectly to diet.

Unless we have a long-term vision, we will soon be overwhelmed by the level of diabetes, cancers and other non communicable diseases that relate to nutrition and exercise. Ultimately, we need to modify behaviors and encourage healthy lifestyles in order to reduce the soaring burden.

Changes in diets and lifestyles in the last 30 years have spurred the recent and rapid rise in chronic diseases, particularly in the Middle East. The traditional nomadic lifestyles based more on herding and agriculture have largely been replaced by a Western lifestyle and diet with far less physical activity.

Our societies now have an abundance of labor-saving devices and advanced technologies that encourage sedentary behaviors which are aggravated by the modern `bigger is better' fast food trend.

Market forces, such as globalization, have greatly affected our region. Large international food companies have changed the way we eat. Eric Schlosser, author of Fast Food Nation, said, “Fast food has joined Hollywood movies, blue jeans, and pop music as one of America's most prominent cultural exports. Unlike other commodities, however, fast food isn't viewed, read, played or worn. It enters the body and becomes part of the consumer. No other industry offers so much insight into the nature of mass consumption.”

It would be naïve to assume we can reverse this mass consumption trend.In a head-to-head battle between the medical establishment and the fast food industry over obesity, my bet would have to be on the fast food industry.

While initiatives have emerged to tax unhealthy food, improve nutrition education and label foods better, there is no global public embrace of that need to eat less and eat responsibly. Retailers and restaurants still sell food in portion sizes and packages encouraging excess eating and waste and that is why a strategy based on cooperation with food companies rather than confrontation is so important. We need them on our side.

It is time to recognize the health and economiclosses we incur from consuming so much food. Public health campaigns worldwide -- including in the Gulf States -- now promote the message that excess weight and lack of physical activity arelinked to heart disease, type 2 diabetes, strokes, and some types of cancer. Is anybody listening? Well, after years of increases, the Center for Disease Control in the US found last year that levels of obesity have finally begun to level off there. Progress is possible.

While public health initiatives often focus more on food consumption, we need to vigorously promote physical activity as well, especially through sports.Sports has had a dramatic health impact on my life and I am a self-confessed fanatic on the connection between athletics and healthy lifestyles.This is also a major thrust of the work we do on the International Olympic Committee.

In August of this year, Singapore will open its doors to 3,000 athletes between the ages of 14 and 18 years in celebration of the first Youth Olympic Games.

In advocating for healthy lifestyles, the International Olympic Committee, is working to reconnect young people with the world of sport. Essentially, they're encouraging teenagers to get off the couch, away from their Facebook accounts, and out onto the playing fields.

We can make much more progress on food -- and on humanitarian emergencies like Haiti, malaria, tuberculosis or AIDS. The money is there and the interest is there. But international aid efforts are too often Western-centric and each year they seem more fragmented, competitive and commercialized to the disadvantage of the developing world. Too often there is a humanitarian "industry" or a humanitarian "bureaucracy" that consumes too much of what is donated.

To give you a personal perspective, when I started Tikiyet Umm Ali in Jordan I joined the ranks of NGOs dealing with hunger issues. We were very much "road workers" doing small, practical and locally designed initiatives to ensure that the future of Jordanian families is not ruined by hunger. But as I moved into my role as a Messenger of Peace and promoting the Millennium Development Goals, I have been more troubled about how we raise and spend money in the aid community.If we are to make progress on issues like hunger or the epidemic of obesity and cope with the massive humanitarian emergencies, the culture of aid must change.

The pledging system in emergencies, for example, is quite daunting and often misleading. For Haiti, the call is out for over 10 billion Dollars. Sadly, donors often pledge aid and then do not deliver it or repackage old projects as new initiatives. In many areas, notably private giving both in the West and the Arab world -- we have very little idea on who is donating what and how.

There have been signs of frustration with the pace of progress on health and food issues. Probably the biggest signal that it is time to do things differently has come from the strong entry of the Gates Foundation into the development field. They have already made wonderful contributions in the area of childhood vaccines and malaria and I am personally very excited by AGRA. It has more of a "road worker" feel to it -- small scale projects, designed by Africans for Africans. The funds may come from abroad but there is none of this “one size fits all”.

No amount of money will ever eliminate the flaws in development that is not sensitive to local need. But how do we get both politicians and the power brokers in the aid community to better appreciate local initiatives, coordinate more effectively on the ground, and harmonize UN and NGO efforts? There are no easy answers. But asyou explore the global challenges that face us in the next few days, please remember these questions and how we can help create a new culture of aid.

Thank you.