Tim Lang, Professor of Food Policy at Thames Valley University, UK, believes that those involved in health must stop talking about outcomes of ill-health and concentrate on altering the determinants - such as the nutritional impact of the food supply chain, starting at the farm. He believes that changing the Common Agricultural Policy (CAP) is a symbol of whether there is real political will to act.
European Union food policy is witnessing remarkable change. (1) Although the new Fischler Reforms under the Mid-term Review do not feature health as a driver for change, after decades in which agriculture dominated not just the finances of the EU but political attention, suddenly other food matters are getting a look in - such as conservation, environmental quality and more equitable trade with developing nations. This is to be welcomed.
The Commission and Council, famous for arcane and complex meetings negotiating new agricultural financial packages, have woken up to the fact that there is more to food policy than the bizarre architecture of farm support or the joys of calculating the cost of labyrinthine wheat and dairy regimes. Fear of unmanageable consumers stalks the corridors.
Food safety in headlines
One health issue is in the politicians’ minds. It is food safety, as we know, that has grabbed political attention. In 2000, the Food Safety White Paper (COM (1999) 719) promised a wide range of new legal initiatives including a consolidating food law and action on issues ranging from labeling to irradiation. The EC Regulation of 8 November 2000 (COM (2000) 716) is now delivering on that process. Even nutrition, long the Cinderella in political attention, got a mention in the White Paper. Not enough, but at least something.
The first major sign of change was symbolized by the creation of a new Directorate General DG SANCO in charge of consumer and health protection. Most recently, the new European Food Safety Authority (EFSA) has been created and started work this year. At the national level, Member States such as Greece, the UK, Ireland and Netherlands have either set up food agencies or are doing so, while aspirant countries now wonder in private whether they, too, should set up agencies. But both these institutional changes are not connecting with the huge budget of the CAP, accounting for nearly half of all EU expenditure.
That said, the rapidly changing institutional landscape demands at least two responses. First, there needs to be an open but tightly monitored system for watching the changes underway. A meeting in Dublin in June 2001, hosted not by the EU but by the World Health Organization’s Office for Europe and the Food Safety Authority of Ireland, began that useful process of finding out what each government was actually doing to reform its food safety and standards institutions and procedures. For some the issue is food safety. For others the issue is wider food and health policy. There is a difference.
Do we need an EFSA?
Second, the public health movement needs to keep a close watch on this process of institutional reform. There is great potential for the EFSA, but sound public health policy would keep asking why is it necessary to have the Authority in the first place? Across Europe, we need to clarify what value agencies add to food policy formulation and implementation. 15 Member States now need to relate with this new Authority. Sceptics argue that the changes are more driven by the need for politicians to be seen to be doing something and to create a "buffer" between them and any blame from food crises than by a genuine desire to shake up food standards and wrench back control from big food companies and the agribusiness that have so long dominated EU food and agricultural decision-making. A proper public health approach such as we hope from EFSA would aim to prevent, not just control, problems.
Making CAP healthy
The Common Agricultural Policy is the biggest illustration of the delicacy at hand. CAP accounts for about half of total EU budgets. In 1998, CAP expenditure was 38,748 million Euros. The problem with CAP is not that it does things badly but that it is based on an out-of-date model of how farming delivers health. CAP was born out of the ashes of World War ll’s food deficiencies. The 1930s hunger framed its designers’ approach. The great architects of CAP and the Food and Agriculture Organisation’s World Food Programme argued that what was needed was to unleash investment and science to raise productivity. If adequately distributed, they assumed that public health would improve. By the mid 1970s, this model was already inadequate but rather than going back to policy basics and asking "what do we want our food system to be and do?" CAP was so enshrined that minor reforms rather than a re-think about its purposes ruled the day. The only conceptual change to the model was to add health education - subsequently criticized as too individualistic and tacitly putting responsibility for food supply onto consumers, a task they cannot possibly execute.
WHO offers a new model
The model by the World Health Organization’s Office for Europe (WHO-E) steered into acceptance by all 51 member states in September 2000. All 15 EU Member States signed onto this new commitment. It provides the model that CAP should be reformed around: a joint commitment to good nutrition, food safety and sustainable food supply.
The WHO-E Food & Nutrition Action Plan endorsed by the Member States at that September 2000 WHO Regional Committee meeting outlined a programme of action and preparation of scientific arguments and data running up to 2005. (2) Since then, workshops have taken place in various European countries and groups of countries, and a progress report will be given to the WHO European regional committee meeting in September 2002. A large scientific background paper is being finalised and is due to be published in Autumn 2002. A Ministerial meeting is scheduled for 2003/4. This offers public health forces an opportunity to rally support and to work with agriculturalists to re-orient CAP.
Happily, this WHO-E initiative coincided with others which could begin to deliver this new model for Food and Agriculture. The first was the EC-funded Eurodiet project, a three year process for setting up a EU-wide system of dietary advice and nutrition information gathering. This process was completed at Crete in May 2000 and made proposals for data-gathering, health promotion and food and health policy. (3)
The second was the little acknowledged but potentially powerful EU French Presidency work culminating in the Brussels Council Resolution of 8 December 2000 with a list of Actions agreed by Health and Social Affairs Ministers. (4) This has led to actions such as Health and Environmental Impact Assessments of CAP in general (5) as well as of particular regimes such as dairy produce. There is talk of the forthcoming Greek and Italian health presidencies (in 2003) taking this process further.
Collectively these are useful steps forward for public and ecological health. At last another vision for CAP reform is available for policy-makers. The existing neo-liberal view of just sweeping it all away is not popular, and a growing body of opinion is wary of delivering Europe’s food system into the hands of powerful agribusiness about whom Europe’s consumers are deeply nervous.
The key insight in the new public health approach to food policy is that what matters is not just safety or whether we eat but how the food is produced and distributed. The reality is that CAP and its sister Common Fisheries Policy are often in conflict with health. An example of this policy conflict is over fish. Across the world, 5% of humanity consume 45% of all meat and fish, while the poorest 20% consume only 5%. The FAO states that 69% of world fish stocks are in "dire condition" and the problem is "having too many vessels or excessive harvesting power in a growing number of fisheries" yet here in Europe, our governments continue to subsidise the fish industry and our fish stocks are in crisis, subject to tighter quotas.
Calculating the real costs
CAP has large externalized costs. These are direct and indirect health costs such as contribution to cardiovascular disease and food poisoning treatment (summarised in the French Presidency document). Environmental assessments for pesticide and nitrate pollution are also measurable for issues such as loss of amenity, cultural dislocation, decline of employment, losses of wildlife, hedgerows, stonewalls, soil erosion and carbon losses from soil.
There is much to do but the stakes are high. There is a fundamental tension between the neo-liberal critique of CAP and the modern cost internalisation position. Finance Ministries favour the former, but must be persuaded as to the advantages of the latter. Ecological and human health analysis of CAP has a complex story to tell.
Europe is blessed with glorious diversity of cuisine, farms and products. But it also shelters hideous inequalities of diet-related ill-health. Ultimately we have to ask: what sort of food system do we want? Is policy in control of the food system or is it, as seems to be the case, in control of us?
An earlier version of this article appeared in Eurohealth, Vol. 7, No. 2, July 2001. Tim Lang revised it and submitted it to Update on 11 July 2002.
References:
(1) Lang T (2000). "Where is European food policy going?", Eurohealth, 5, 4, 28-30
(2) WHO (2000). Resolution: The Impact of Food and Nutrition on Public Health: the case for a Food and Nutrition Policy and an Action Plan for the European Region of WHO 2000-2005. Regional Committee for Europe, Fiftieth session, Copenhagen, 11 - 14 September 2000. Copenhagen: World Health Organisation Regional Office for Europe. EUR/RC50/R8
(3) These are summarized in a special issue of Public Health Nutrition, 2001, 4, 1(A), February
(4) French Presidency (2000). Working Paper: Health and Human Nutrition: Elements for Action. Brussels: European Commission. August 24, 2000
(5) The Swedish Board of Agriculture has just published an impact assessment. A summary in English is available at www.sjv.se (Miljöeffekter av EU:s jordbrukspolitik, rapport 2002:2.).
Info:
Tim Lang PhD, Professor of Food Policy
Centre for Food Policy, Wolfson Institute of Health Sciences
Thames Valley University
St Mary’s Road, Ealing
London W5 5RF, United Kingdom
Tel: +44 208 280 5070; PA/secretary tel: +44 208 280 5123
Fax: +44 208 280 5125
Email: tim.lang@tvu.ac.uk
