Diet and Health: Diseases and Food 289above is surely an answer to this position. The costs of what is presented as an
‘individual’ problem are, in fact, society wide. The ill health that results is paid for
either in direct costs or in a societal drag – lost opportunities, inequalities and lost
efficiencies. This is why policy makers have to get to grips with obesity and the
world’s weight problem.
Both obesity and overweight are preventable. At present the debate about
obesity is divided about which of three broad strategies of action is the best to
address. One strand argues that it is a problem caused by over-consumption (diet
and the types of food) and oversupply; another that it is lack of physical activity;
and the third that there might be a matter of genetic predisposition. Certainly, the
emphasis has to be on changing the environmental determinants that allow obesity
to happen. A pioneering analysis by Australian researchers in the mid-1990s pro-
posed that the obesity pandemic could only be explained in ‘ecological’ terms:
Professors Garry Egger and Boyd Swinburn set out environmental determinants
such as transport, pricing and supply; they claimed that environmental factors
were so powerful in upsetting energy balances that obesity could be viewed as ‘a
normal response to an abnormal environment’.^69 So finely balanced are caloric
intake and physical activity than even slight alterations in their levels can lead to
weight gain. Swinburn and Egger assert that no amount of individual exhortation
will reduce worldwide obesity;70,71 transport, neighbourhood layout, home envi-
ronments, fiscal policies and other alterations of supply chains must be tackled
instead.
Calculating the Burden of Diet-related Disease
During the 1990s, world attention was given to calculating the costs of what has
been called the ‘burden of disease’. Five of the ten leading causes of death in the
world’s most economically advanced country, the US, were, by the 1980s, diet-
related: coronary heart disease, some types of cancer, stroke, diabetes mellitus and
atherosclerosis. Another three – cirrhosis of the liver, accidents and suicides – were
associated with excessive alcohol intake.^72 Together these diseases were accounting
for nearly 1.5 million of the 2.1 million annual deaths in the US. Only two catego-
ries in the top ten – chronic obstructive lung disease and pneumonia and influ-
enza – had no food connection.
In a 1990s study published by the World Bank, The Global Burden of
Disease,^73 the authors Murray and Lopez gave a detailed review of causes of mortal-
ity in eight regions of the world. Ischaemic heart disease accounted for 6.26 million
deaths. Of these, 2.7 million were in established market economies and formerly
socialist economies of Europe; 3.6 million were in developing countries (out of 50.5
million deaths from all causes in 1990). Stroke was the next most common cause of
death (4.38 million deaths, almost 3 million in developing countries), closely
followed by acute respiratory infections (4.3 million, 3.9 million in developing