A Pluralistic Approach to Non-Communicable Diseases

Bridging the Gap Between Food and Agriculture and Public Health

More than five years have passed since the 2011 United Nations high-level meeting on the Prevention and Control of Non-communicable Diseases (NCDs). NCDs such as cardiovascular disease, cancer, diabetes, and chronic lung disease are a leading cause of mortality worldwide, responsible for more than 30 million deaths annually. These diseases alone place an enormous burden on health systems, representing $2 trillion a year in health costs, and the projected toll in lost economic output by 2030 is a staggering $47 trillion. Beyond the impacts on economic output, NCDs will continue to deepen poverty and impede our collective ability to achieve the UN Sustainable Development Goals.

The complex and challenging NCDs landscape is affected by many risk factors and social determinants related to food and agriculture. Factors such as malnutrition, obesity, and food insecurity all contribute to NCD prevalence. Nevertheless, there is no one multi-stakeholder platform that enables a cooperative dialogue about the link between food and agriculture and public health. The current debate on NCD prevention and control is therefore subject to tensions among stakeholders – particularly between civil society and the private sector. These divisions complicate and undermine efforts to both understand and solve the NCD challenge. An effective response must instead move from conflict to finding synergies and establishing collaboration because no single type of stakeholder can solve the problem by itself.

…there is no one multi-stakeholder platform that enables a cooperative dialogue about the link between food and agriculture and public health. The current debate on NCD prevention and control is therefore subject to tensions among stakeholders – particularly between civil society and the private sector. These divisions complicate and undermine efforts to both understand and solve the NCD challenge. An effective response must instead move from conflict to finding synergies and establishing collaboration because no single type of stakeholder can solve the problem by itself.

The newly formed Alliance for Food & Health (AFH) aims to bridge these differences by committing to fight NCDs through a multi-stakeholder process designed to engender novel, collaborative approaches. With more than 200 participants representing civil society, the private sector, international organizations, academia, scientific bodies, and others, the AFH is creating a model that encourages cooperation to address critical health issues. Through stakeholder engagement, the AFH can generate ideas to influence policy and propose interventions that will inform the debate on NCDs, particularly regarding obesity. These ideas and recommendations will be presented in a series of White Papers with topics chosen by AFH participants. The first White Paper focuses on encouraging fruit and vegetable consumption and will be completed this spring.

The AFH model is distinctive in the following ways:

  • It is diverse. With participants ranging from farming groups to public health experts, the AFH considers the food and health system as a whole – instead of just its isolated parts. To ensure maximum participation, it does not have a formal membership structure – but instead engages with participants on an informal but substantive basis. In addition to promoting strength through diversity, the model offers a highly interdisciplinary platform that includes public health, economics, nutrition, logistics, public administration, and marketing, among other fields. It intends to create a hybrid vigor of ideas to transform how stakeholders can respond with actionable, sustainable solutions to the NCD challenge.
  • It is based in science. The White Papers will be data-driven and evidence-based. To ensure quality, these will draw from participant subject matter expertise and from peer-reviewed scientific literature.
  • It is balanced. The AFH has a governance structure that encourages balance in all of its deliberations – from the working groups to its leadership. Of particular value is the balance between the food and agriculture participants and the global health participants, each of whom welcomes the opportunity to learn from the other. This overlapping system of checks and balances increases the chances for a group consensus and minimizes interest group biases to advance the common good.
  • It values learning. Feedback from diverse stakeholders informs AFH discussions and enables them to evolve and improve. As an example, the foundational documents have seen 24 revisions in response to comments from participants. Through this process, AFH participants educate themselves and each other toward the common goals of reducing NCD morbidity and mortality.
  • It values trust. By encouraging participant feedback, the AFH has shown steady growth in its number of participants. As a testament to the stakeholders’ appreciation for the diverse dialogue, word of mouth from existing members continues to attract new participants. In order to build confidence in the process and openness in communication, the dialogue follows Chatham House rules, where participants can share ideas in confidence and commit to solving problems together. These approaches have enabled the AFH to maintain trust as it has expanded.
  • It is action-oriented. The White Papers will deliver actionable proposals to governments, the private sector, and civil society. Since AFH strives for maximum social impact, it focuses on innovation rather than on finding an acceptable but ultimately ineffective lowest common denominator.
  • It is mission-focused. The vision for a better world sees fewer people harmed by NCDs through effective interventions where it matters most. By positioning itself at the nexus between food and health, the AFH bridges a gap through information gathering and consensus building.

While the AFH’s pluralistic approach has certainly presented challenges, it is critical to finding and addressing the root causes of specific NCDs. By starting with a clear problem definition, for instance that poor diets are causing obesity, a consensus can bring diverse stakeholders together into a meaningful and targeted discussion. Given the complexities of creating a broad partnership spanning multiple sectors and industries, the AFH’s shared vision allows it to be stronger and more capable of outlining a collective path forward that can make a real difference.

Creating the AFH has led to valuable lessons about building strong partnerships around controversial issues. Two key lessons stand above the rest — mutual respect and the need to build trust in the process and each other. It is critical to minimize the effects from individuals who bring their biases into the group and from any attempts to affect the process based on perceived leverage such as resources or influence. So far, the ability to recognize the value of each type of stakeholder has kept the AFH on track. Using these basic principles, the AFH hopes to take great strides towards mitigating the costs of NCDs and paving the path for others towards achieving the Sustainable Development Goals. As we look to transform the debate on NCDs, we encourage you to join us in finding a better way forward – together.

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