Better foods systems for better health equity: Interview with Karin Schindler

Karin Schindler is a Nutritional Scientist and head of the department of Mother, Child, Adolescence and Gender Health and Nutrition in the Austrian MoH. In this function she is responsible for organizing the conference “People’s food – people’s health: Towards healthy and sustainable European Food Systems” during the 2018 EU presidency which she announced at the Forum 12: Sustainable strategies for addressing health inequalities.

AF: How do we need to change food systems to better foster health equity?

KS: Through collaboration, finding co-benefits and avoiding market failures. Collaboration means that those who work along the food value chain in the different sectors leave their silo and come together and find the benefits of collaboration.

AF: So, which sectors would that be?

KS: Starting with the agricultural sector, farming but also fisheries, food processing, transport, trade, retail, consumer sector… We also have to think further to avoiding waste.

AF: What are the co-benefits of investing in equitable food systems for the other sectors?

KS: For example, if you shorten the food supply chain, so that fresh fruit fresh vegetables are easily accessible and affordable for consumers you also reduce transport. That’s good for the environment. Also, the farmers can benefit through a better economy, as well as the entire rural areas because staying in a rural area is more attractive when you can participate in the economy.

AF: Can you think of any best practice examples?

KS: Yes, there is a very nice best practice in Copenhagen where they have changed public procurement: they now buy organic foods from the area. Through that, they made an impact on the drinking water quality in the area.
They scaled up by educating those who work in public procurement, chefs and restaurant workers, to spike up their interest in producing these foods or dishes. It works well and shows these initiatives can actually work within the larger community.

Another one is sugar taxation in the UK. I am not 100% convinced but announcing the possibility of a sugar tax made producers reduce sugars in beverages. Unfortunately, they replaced sugar by artificial sweeteners, so they kept the level of sweetness, which I think we should avoid. We should reduce our appetite for sugar, and this is about a habit that you learned while growing up.   

AF: So, can we incentivise producers to actually do that?

KS: I think the only incentive is regulation, to say “you have to reduce the sweetness and the sugar content”. Additionally, the consumers should be well-informed and make informed choices.

We had a good example in Austria – the national broadcast institute did a campaign on sugar. It was enormous!  Most of the TV broadcasts were included in the event. The people started talking about sugar, the outreach was enormous. It’s still something people often mention – “Oh you are drinking this? It has so much sugar!” Honestly, I don’t know how much sugar some things have, because I don’t drink it anyhow, but people got interested and this changed their habits.

AF: So, do you think the campaign actually had a sustainable impact?

KS: In this case, I think so. But there is also a report by the World Bank that states that campaigning is the least influential method. Reduced portion size is seen as most influential, which makes sense – if you offer a smaller portion size, people will eat less. The same goes with the processed foods – if there are smaller portion sizes people will hopefully eat less, as long as it is not too small, or if it’s not a big pack with a lot of small pieces in it.

AF: Why do you personally care about equity in nutrition?

KS:  Because I have the experience of more than ten years working in a hospital in an out-patient clinic with morbidly obese patients and with patients with diabetes. This experience has taught me about the importance of the “I have the choice” and “I can change” attitudes. It’s not easy, because behaviour is something you learn very early in your life. To change something which has been a part of our mind-set for 40-50 years is very difficult!

I have also seen that, if somebody is working hard the whole day, the healthy choice has to be the easy choice! If you go through the supermarket and you don’t have much time for shopping, you want to have the healthy things easily available.

AF: So, there are many systemic factors that influence our ability to make informed choices. And you mentioned nudging…

KS: Yes, yes!

AF: We know now why you personally care about the topic, but why do you think decision makers should care about the topic and put it high up on the agenda?   

KS: The topic of healthy eating?

AF: Healthy eating and equity.

KS:  I mean, we have the data, it’s so clear that health and lower socio-economic status are closely linked. If we don’t dedicate our time to these facts, the gap will increase between the wealthy and those who have only little money in their pockets, and this is not fair. Basically, what happens is that if you are born in an environment which provides few chances, this probably means bad health in the end – and that’s just not fair!

AF: And why should the minister of finance care about this?

KS: Well, because if we don’t find solutions to solve problems of overweight and obese people, as well as the increasing numbers of people with diabetes (with a very early onset!), it will end up costing a lot.  

Thirty years ago, diabetes was a disease of the aged – now it’s already a disease of much younger people. You have to imagine a young person, 30 years old, becoming diabetic, which means needing therapy, starting with Metformin, and then needing insulin. The medication is expensive, but that’s not even the biggest issue: these people are more often on sick leave, they are stigmatized on the labour market, they cannot find jobs, which means they stay at home, they get depressed, they need further medication… This is just a vicious cycle, and it ends up costing the society a lot of money.

AF: And all of these consequences and economic costs would be preventable if we enable a healthy start in life?

KS: I think they are preventable. I mean, there is a question we need to ask: “how long do people suffer from diabetes?” Diabetes used to be a disease of the elderly, but now it can start much earlier and can last for a lifetime. Even with reduced life expectancy, there are many, many years where a lot of money is spent. That’s it.

The interview was conducted by a Young Gasteiner Anna Fox

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