By José Graziano da Silva
ROME, May 5 2015 (IPS)

In the last half-century, people’s lifestyles have changed dramatically. Life expectancy has risen almost everywhere, but this has been accompanied by an increase of so-called non-communicable diseases (NCDs) – such as cardiovascular diseases, cancer, respiratory diseases, and diabetes – causing more and more deaths in all corners of the world.

José Graziano da Silva. Credit: FAO/Alessandra Benedetti

My distinguished colleague Dr Margaret Chan, Director-General of the World Health Organization (WHO), has called the worldwide rise of NCDs a “slow-motion catastrophe”. If NCDs were once considered the scourge of the developed world, this is no longer true; they now disproportionally affect low- and middle-income countries where nearly three-quarters of NCD deaths – 28 million per year – occur.

Much of the rise of NCDs can be attributed to unhealthy diets. WHO estimates that 2.7 million deaths every year are attributable to diets low in fruits and vegetables. Globally unhealthy diets are estimated to cause about 19 percent of gastrointestinal cancer, 31 percent of ischaemic heart disease, and 11 percent of strokes, thus making diet-related NCDs one of the leading preventable causes of death worldwide.

In other words, diet determines health – just as bad diets can lead to disease, healthy diets can contribute to good health.

But what exactly is a healthy diet? This is a difficult question. Generally, a healthy diet must provide the right nutrients in the right balance and with sufficient diversity, limiting the intake of free sugars to less than 10 percent of total energy requirements, and keeping salt intake to less than 5 grams per day.“There is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences”

However, there is no one-size-fits-all healthy diet. A healthy diet must be affordable, based on locally available foodstuffs, and meet cultural preferences. For over 20 years, FAO, together with WHO, has worked with governments on national Food-Based Dietary Guidelines: short, science-based, tips on healthy eating, in accordance with local values, customs and tradition.

Healthy meals do not always taste or look the same. Take, for example, the Mediterranean and Japanese diets: very healthy and completely different.

The Mediterranean diet revolves around the consumption of legumes, cereals, fruits and vegetables, olive oil, fish, and moderate consumption of dairy products (mostly cheese and yogurt). It emphasises unprocessed, plant-based foods, such as fruits and vegetables, in addition to the consumption of beans, nuts, cereals and other seeds; olive oil is the main source of (unsaturated) fat.

Japanese cuisine, on the other hand, is often associated with sushi (raw fish with rice), and sashimi (fresh raw seafood). The Japanese diet emphasises at least seven ingredients: fish as a major source of protein; vegetables including daikon radish and sea vegetables; rice; soya (tofu, miso, soya sauce); noodles; fruit; and tea (preferably green).

The Japanese and Mediterranean diets are examples of healthy diets. They use a great variety of ingredients; they are rich in plant foods including vegetables and fruit, legumes and fibres; they are modest in red meat; and they utilise many natural herbs and spices instead of salt to flavour food.

Both diets are linked to peoples and cultures as much as to their natural environment: it therefore comes as no surprise that both the Mediterranean diet and the Japanese diet have made it onto UNESCO’s World’s Intangible Cultural Heritage list.

The health benefits of the Japanese and Mediterranean diets are promising. Japanese enjoy one of the longest average life spans in the world – 87 years for women and 80 for men. In Mediterranean countries such as Italy and Spain, women have a life expectancy of 85 years. The figure for Italian men is 80 years, the same as their Japanese counterparts. All of them are above the average of high-income countries: 82 years for women and 76 years for men.

Medical research also indicate that that the Japanese diet leads to the lowest prevalence in the world of obesity – only 2.9% for Japanese women – and other chronic diseases like osteoporosis, heart ailments and some cancers. On the other hand, the Mediterranean diet, if followed for a number of years, is known to reduce the risk of developing heart disease, cancer, hypertension, Type 2 diabetes, Parkinson’s and Alzheimer’s disease.

In sum, adhering to a healthy diet helps you to not only to live longer, but also to have a better quality of life. Conversely, a bad diet causes malnutrition and can expose you to a range of NCDs.

A modern paradox is that many countries – including developing countries – suffer from undernourishment on the one hand, and obesity and diet-related diseases on the other. And while FAO’s chief concern is to eradicate hunger in this world, we cannot separate food security from nutrition. FAO – together with our U.N. agencies – considers food and nutrition security a basic human right.

In all cases, the cost of malnutrition goes beyond the health of the individual: it affects society as a whole in terms of public health costs and loss of productivity, and, therefore, is an issue that must be addressed through public and coordinated action.

Last year’s Second International Conference on Nutrition (ICN2), organised jointly by FAO and WHO, sent a clear message in that direction. The two outcome documents of ICN2, the Rome Declaration on Nutrition and the Framework for Action that commit world leaders to establishing national policies aimed at eradicating malnutrition and making nutritious diets available to all.

A key message from ICN2 is: governments have a central role to play in creating a healthy food environment to enable people to adopt healthy dietary practices. Yes, it is consumers who choose what to eat, but it is the government’s role to provide the enabling environment that encourages and makes healthy choices possible. (END/COLUMNIST SERVICE)

Edited by Phil Harris   

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

Excerpt:

As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

By Sam Olukoya
LAGOS, Nigeria, Nov 21 2014 (IPS)

Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children.

“The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future Savers Initiative, told IPS.

“Shola felt as an outcast,” says Akinpelu. Eventually, Shola’s grandparents took him in.

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the leading cause of death among adolescents.

“This is absolutely unacceptable,” says Craig McClure, chief of HIV programmes with the United Nations Children’s Fund (UNICEF), in New York. “What’s more, AIDS-related deaths are decreasing for all age groups except adolescents.”

The global AIDS death toll fell by 30 percent between 2005 and 2012 but increased by 50 percent among adolescents, says a UNICEF report.

Fear of seeking help

One reason for this shocking teen death toll, says Dr. Arjan de Wagt, chief of HIV/AIDS with UNICEF in Abuja, is the low number of adolescents on antiretroviral treatment (ART).

Of the 3.1 million Nigerians living with HIV, half are under 24 years. But only two out of ten HIV positive youth over 15 and just one out of ten under 15 received the lifesaving drugs in 2013, de Wagt told IPS.

Rejection by family and society, as happened to Shola, or fear of rejection, prevents adolescents from seeking help.

“Many HIV positive adolescents are dying in silence because they are too ashamed to access treatment,”’ Blessing Uju, a Lagos-based youth counsellor, told IPS.

“The shame is even bigger for the girls. In Nigeria, if you are HIV positive, the impression is that you are a commercial sex worker,” she says.

Sally* did not tell her parents or siblings when she tested HIV positive four years ago, at age 19.

“At the family level, there is a lot of stigma,” she told IPS.

Although aware of the danger of not taking her medication regularly, Sally often skipped it to avoid being seen with pills at home.

“As a young person, you need a confidant. If you are not strong, you might end up taking your life,” she says.

Teenagers need family help to stay on ART, says Akinpelu.

Shola’s grandparents would normally cook the first meal for the day in the afternoon until Akinpelu explained to them that the pills can cause nausea on an empty stomach and Shola needed a hearty meal earlier.

Uju says that treatment fatigue hits adolescents hard. “Some say they prefer to die than to continue taking their drugs,” she says.

High death toll

Of the 2.1 million adolescents living with HIV worldwide in 2012, more than 80 per cent are in sub-Saharan Africa, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Malawi, with 93,000 HIV positive teenagers, has 6,900 annual AIDS-related adolescent deaths.

The death toll is linked to late diagnosis and starting ART too late, explains Judith Sherman, of UNICEF in Lilongwe.

Malawi’s policy is that all children seen in health facilities should be offered an HIV test. “Unfortunately, this does not happen routinely,” she says.

Teenagers’ adherence to ART is lower than adults, says Sherman, “for a range of reasons like treatment fatigue, depression, fear of stigma, denial and unstable family relationships.”

Tanzania’s estimated 165,000 adolescents living with HIV face similar challenges as their peers in Nigeria and Malawi. (see sidebar)

Allison Jenkins, chief of HIV/AIDS with UNICEF in Tanzania, says that one effective way to help teenagers are clubs.

“Teen clubs improve adherence to treatment, especially among members who attend regularly,” she told IPS.

HIV among teen girls

Alarmingly, adolescent HIV prevalence is highly gendered, with teen girls showing infection rates that UNAIDS calls ”unacceptably high”.

Teen girls aged 15-19 in Mozambique have a prevalence of seven per cent, more than double the boys of the same age. Botswana presents a similar scenario.

Lucy Attah, of the Lagos-based Women and Children Living with HIV & AIDS, blames poverty.

“Girls have to trade sex for money to sustain themselves,” she says. “The pressure for money is higher in the cities where teenage girls compete to get the best mobile phones and clothes.”

Adolescents become sexually active, try drugs and alcohol, feel invulnerable, and experience the social and economic pressures of becoming an adult. HIV and the lack of youth-friendly health services compound the problem, says the UNICEF report.

 “We must do more and do it well, focusing on sub-Saharan Africa and on adolescent girls, where the heaviest burden lies,” says McClure.

*names changed to protect privacy

Edited by Mercedes Sayagues