Opinion  

Diet and healthy nutrition have been on the health agenda for some time, particularly in relation to CHD and cancer prevention.  However, the rapidly increasing prevalence of obesity across the developed world has made this a political priority as well. 

Governments, including our own, are keen to tell us how to choose healthy diets. Public health practitioners know that the environment within which choice is made is the real determinant of lifestyle. The availability and price of healthy food choices is key. However, governments are slow to take account of this and our traditional arrangements for food production and subsidies encourage unhealthy food choices.

Milk and beef are the most subsidised products
The Common Agricultural Policy (CAP) was set up, by the EEC (an antecedent of the EU), in the aftermath of war and famine, to ensure that henceforward Europe would enjoy food security by safeguarding the position of farmers in the countryside through subsidies. At the outset, the industrial cities of Germany (where there had been starvation less than a decade before) demanded dairy products and meat, so milk and beef production became the most subsidised farm products.  

The trouble is that, although there have been many minor reforms of CAP, this basic situation has remained unchanged ever since. Thus we still have over-production of massive quantities of subsidised beef and milk that are now disposed of by the EC which, using even more subsidy, sells them cheaply to the food industry.

The problem is that dairy products and beef are saturated fat-rich products and a direct cause of the high mean levels of serum cholesterol across northern Europe. They are also calorie-rich, contributing significantly to obesity. Excess dairy fat is sold cheap to industry and, as such, is the cheapest fat available for making pies, pastries, biscuits and cakes. So even though people are taught to buy low-fat dairy products, they get the saturated fat back when they buy pre-made products.

There is minimal CAP support for more healthy foods
Meanwhile, all those foods we would like to encourage people to eat, such as fruit and vegetables, have only ever attracted minimal CAP support. So if the CAP could be reformed to promote healthy nutrition what would it look like? Over time farming subsidies would be transferred from health-damaging production of cows to support  production of healthy foods, such as fruit and vegetables, so that these would become more available and at cheaper prices.  

Excess dairy fat would no longer be unloaded into schools and hospitals, with only low-fat dairy products made available cheap to public sector organisations. In place of saturated fat, production of more unsaturated oils and fats would be encouraged. Cereal production would continue to attract support, but for human consumption not for the fattening of more livestock in which it would be converted to saturated fat.

CAP reform is on the political agenda in 2008, which is why the Faculty of Public Health is becoming involved in this debate. Will the EC, and member state governments like our own, put health at the top of the agenda for the first time and at last to take on the powerful food industry and farming lobbies?

Dr Christopher A Birt is a public health physician with particular interest and specialisation in cardiovascular epidemiology and European public health. He is co-chair of the board of trustees of Heart of Mersey, a CHD primary prevention charity he was instrumental in creating, which operates over Merseyside and beyond. Dr Birt leads for European public health for the North West Region and is part-author of two publications concerning health and the CAP.