I heard Derek Yach speak at Albert Einstein's Global Diabetes Summit last September. He presented a case to curb obesity, hunger and diabetes that we don't often hear: turn our agricultural policies around and work more closely with farmers.
Mr. Yach -- a physician and epidemiologist -- is a noble fish trying to change the sea around him and around us. Formerly an Executive Director at the World Health Organization (WHO), Yach is Senior Vice President of Global Health and Agriculture Policy at PepsiCo.
Yach's mission is to help address global challenges such as hunger and obesity, and the ills they cause, by finding ways for PepsiCo -- the world's second largest food and beverage business -- to be a part of the solution.
Yach is the 15th leader featured in my series on diabetes change agents. This is Part 1 of a two-part interview. Yach talks here about the world situation and our agricultural policies. Part 2 covers what role PepsiCo is playing.
Q: When you were at the World Health Organization you were instrumental in reducing smoking. Why is it so much harder to get food companies and consumers on the path of producing and eating healthy food?
Derek Yach: Reducing tobacco use was much simpler. You demonize the industry, then tax it to the sky, ban marketing and reduce smoking in public places. Those are all very crude, easy things to do. They don't have the nuance of a diet, the complexity of the thousands of things available for people to eat or the numerous invested parties.
What makes food complex to regulate according to Yach:
1. You can consume too much of a healthy food, and then it is no longer healthy.
2. Everyone thinks they're an expert -- the consumer, the policy makers, agricultural people, politicians, dietitians, nutritionists -- yet no one has come up with clear and coherent strategies.
3. Everything you ask people to eat less of has enormous interests behind it. If you want people to eat less meat, there's a red meat lobby and a Cattleman's lobby.
4. The groups that are asking people to eat more healthy foods, like fruits vegetables, whole grains and beans, don't advocate their causes very effectively.
I think we're going to need incentives rather than regulations. And we'll need to apply them all the way along the agricultural supply chain and human behavior. There isn't one single instrument, as we had in tobacco, that's going to change food consumption for the better. It will take years of different interventions to reverse the trends we see today in obesity.
Q: What has to happen regarding agricultural policies in order to help stem the tide of obesity and diabetes?
DY: Simply, we need a far more nutrition-focused perspective embedded in agricultural policy. In terms of health, our food policies have failed miserably. The escalation of diabetes around the world is an indicator of how off course we've gone.
As an epidemiologist I look at trends and see problems before they begin and things getting better before it's noticed.
The public hasn't yet seen our agricultural policies translate into a direct impact on diabetes-related death, but it has. And, they are having significant consequences regarding increased diabetes, ill health and health care costs.
Q: What else needs to happen at a national and global level?
DY: In the public sector, agricultural and health departments need to be brought closer together to align their priorities, specifically for diabetes. Our current support structure and subsidies are for meat, not fruits and vegetables, and we need just the opposite.
We need to more closely link farm subsidies with the prevention of chronic disease, and that means we need to play a more active role with our agricultural partners. Farming and agriculture play a root role in the quality of calories we furnish, and right now we have an energy imbalance.
We are caught between hunger in the world and obesity and both come from the same cause: cheap calories. We must play more actively with our partners in agriculture.
Fruit and vegetable consumption will also be helped if the relative price of fruits and vegetables become more competitive with corn, corn syrup and sugar-related products. Then companies will want to innovate and use those products across their product lines and this will benefit both companies and consumers.
Q: How can governments and businesses work more closely with agriculture to stem the tide of obesity and produce more healthful foods?
DY: That's the critical question. When I was at the WHO, one of the things we failed to do when working on diet and physical activity policy was persuade agricultural organizations to look at what agricultural supply would be if it was meeting the health and nutrient needs of the world. I think that's the intimate bridge between what gets grown and what is needed from a health point of view.
In the U.S. the structure for agriculture did not start by asking the question, "How can we make sure that the healthiest foods are those we grow the most of and are most available in terms of pricing, availability and accessibility?"
Q: What question underlies the food industry in the U.S.?
DY: I think it's one of agricultural output, "How do we increase yield and maximize yield output for the return of farmers?" That's an important question but what we need to ask is, "How do we maximize the use of agriculture to meet nutrition needs?"
The good news is the World Economic Forum is now asking the question. Many domestic discussions are on how we can meet the gap in fruit and vegetable consumption. And, it's part of the bigger, complicated issues around subsidy structures and research and development for fruit and vegetables as opposed to soy, corn and palm oil. And the food industry's toughest critics, like Michael Pollan and Marion Nestle, as she reviews farm bill issues, are asking the question. But this shift will not happen overnight since we've built our current system up over many decades.
In Part 2 of my interview Yach talks about PepsiCo's commitment to health and wellness.
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Riva speaks to patients and health care providers about flourishing with diabetes and is the author of "50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It" and "The ABC's Of Loving Yourself With Diabetes." Visit her website DiabetesStories.com.