With more than 1 million deaths in just nine months, COVID-19 is a sobering reminder of how fragile global health can be. Sadly, cardiovascular disease will kill more than 10 times as many people this year. And the two health threats reinforce each other.
One important strategy to reduce illness and death from heart disease is the elimination of artificial trans fat from the global food supply. This toxic substance used in food increases the risk of heart attack and death; eliminating it could save 17 million lives over the next 25 years. And it is economically, politically, and technically feasible to eliminate trans fat and replace it with healthier alternatives. The World Health Organization’s REPLACE technical package aims to make the world free of trans fat by 2023.
WHO’s second progress report on global trans fat elimination showcases important advances toward ridding the global food supply of artificial trans fat and calls for increased focus on regional action. Best-practice policies for artificial trans fat elimination are now in full effect for almost 590 million people in 14 countries, and 39 countries will be protected by best-practice policies by the end of next year.
Many countries, including Brazil and Turkey in the past year, are choosing to adopt best-practice policies for complete elimination, rather than regulations that permit some continued use of trans fat. India and Nigeria, among others, have stated that they will follow suit this year. And some countries with less restrictive measures are now updating their policies to align with best practices for elimination.
Addressing root causes of cardiovascular disease … does not detract from the COVID-19 response, but rather protects a vulnerable group and creates more resilient populations.—
However, more than 100 countries still permit this harmful chemical compound in their food, leaving billions of people at increased risk. Of the 15 countries with the highest burden of death from trans fat consumption, only four have implemented or enacted best-practice policies to protect their populations.
Meeting WHO’s ambitious goal of a world free of artificial trans fat by 2023 will mean picking up the pace. This won’t be easy, especially given the ongoing global focus on the pandemic. But the time is right.
With COVID-19, eliminating artificial trans fat is now more important than ever. This will reduce the strain on health systems overwhelmed by the pandemic, particularly in countries where treatment services for heart disease and other noncommunicable diseases have been disrupted. Addressing root causes of cardiovascular disease, including trans fat consumption, does not detract from the COVID-19 response, but rather protects a vulnerable group and creates more resilient populations while reducing the burden on health care facilities.
Given this urgency, action from regional bodies should be a priority. Regional regulations protect more people than country-level policies and require less investment from individual countries.
Three regional bodies have put in place regulations to eliminate trans fat — the Eurasian Economic Union, the Cooperation Council for the Arab States of the Gulf, and the European Union — potentially reaching 41 countries and protecting more than 700 million people.
Regional regulations extend trans fat protection to countries with limited resources or regulatory capacity and where trans fat elimination is not yet a priority. They also allow for strong enforcement of regulations and proper implementation with less burden on individual member states. Regional action can protect consumers in lower-resource countries, which have been slower to limit trans fat from their food supplies.
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In addition to protecting more people, regional regulations for trans fat also make sense economically. Because of the globalized nature of the food supply, food is often shipped across country borders. When an entire region adopts the same standards, food manufacturers can repackage the same products for sale in multiple countries of that region. This can reduce research and development costs and facilitate trade within a region.
Health benefits may extend to countries bordering those covered by the regulation, as companies that eliminate trans fat from products in regulated markets may find it easier and cheaper to reformulate those in nearby unregulated markets. Additionally, food producers in unregulated regions will be incentivized to reformulate their products so they can sell their products in regulated regions.
This regional approach can be a model for Africa and Asia, where there has been limited progress on trans fat elimination. Most policy actions to date have been in higher-income countries and in the WHO regions of the Americas and Europe. No low- or middle-income nations have yet adopted best-practice policies for trans fat elimination, yet these countries make up most of the world’s population and their people are at higher risk of death from heart disease.
Elimination of artificial trans fat from the global food supply is a WHO priority and is a cost-effective intervention to reduce heart disease. The many countries that have already eliminated trans fat show that it is possible to accomplish this quickly. A healthy oil change will save millions of lives and reduce health care costs — and because trans fat doesn’t change the taste or cost of food, only our hearts will know the difference.