September 4, 2014
Know your heart challenges the notion that health is solely an individual's responsibility.
In this book, author Dinesh C Sharma exposes how the government is keeping us unhealthy
ARE YOU free to be healthy? Can you cut back on junk food, jog around and reduce booze and cigarettes of your own will? "Yes," you might say, "we live in a democracy and can choose how to live." You are right but only partially. In the present times, junk food pervade not just the food courts but also what's cooked in our home kitchens, most of the open spaces for walking and jogging have been turned into parking lots and it's quite easy to relapse into smoking with surrogate tobacco promotions all around us.  In fact, when it comes to choosing between various options, we don't have an absolute say.
The State has already got that covered.
All this and more has been detailed in 'Know your heart', a book by science and health writer Dinesh C Sharma (Disclosure: I have worked with the author in a daily newspaper for three years). The long journalistic career of Sharma has helped him pen this book which is less about heart ailments and more about how government policies have turned us into sitting ducks for these diseases. The number of coronary heart disease cases in India is expected to reach 61 million cases by 2015 and the reason for this rise can be traced to government policies. The book focuses on three risk factors: Junk and processed food, Physical inactivity and Tobacco.
Though researchers often blame a faulty gene for the high incidence of heart disease in India, Sharma terms it a minor factor which can be managed if we lead a healthy lifestyle. However, our government has, over the years, come up with various penalties for pursuing these healthy activities. On the other hand, industries promoting unhealthy lifestyle get hefty subsidies. The book starts with details on rising burden of non-communicable diseases in India which seem unnecessary as most of the readers are likely to already know about the current crisis. It soon picks up pace as Sharma dives into the food environment and how 'Brown revolution' impacted our choices.
Our government has, over the years, come up with various penalties for pursuing these healthy activities. On the other hand, industries promoting unhealthy lifestyle get hefty subsidies. 
The author presents thought provoking evidences done on various subjects including seemingly harmless white rice, imported palm oil, colas, potato chips and even street food. In addition, how food companies influence the consumers through promotions disguised as public welfare campaigns has also been brought out well. "Egg intake went up because one poultry industry- Venkateswara- decided that Indians should eat eggs every day, thereby increasing their egg protein, fat and cholesterol intake," he writes. The author takes us to corridors of power where industry representatives dominate expert committees, suggest advocacy campaigns and frame rules. In a way, as mentioned by him, "the regulated become regulators."
Egg intake went up because one poultry industry- Venkateswara- decided that Indians should eat eggs every day, thereby increasing their egg protein, fat and cholesterol intake
The second chapter talks about our physical environment where preference to private transport has turned most cities into navigational nightmares. Cars have encroached upon walking and cycling spaces thus making good health a right reserved only for those who can afford a club membership or buy costly home gadgets to stay fit. The third part focuses on tobacco and though a lot of the information provided is in public domain thanks to consistent anti-tobacco campaigns, Sharma offers a more concerted view. "Government helps the industry in testing, developing new packaging technologies and even conducts market research and then rewards the best performers...the Indian taxpayer is funding the growth of an industry which threatens the very health of the taxpayers," he points out. Movement of files on tobacco regulation from one ministry to another, influence of manufacturers and dilution of rules have been explained in detail.
Government helps the industry in testing, developing new packaging technologies and even conducts market research and then rewards the best performers...the Indian taxpayer is funding the growth of an industry which threatens the very health of the taxpayers,
The thing that works best for the book is the data from various research studies that have been quoted to support the observations. For this, the writer's long experience as a health and science journalist has come handy. One of the main contentions that Sharma raises is that policymakers justify most of the concessions to food processing, automobile and tobacco industry by claiming this will help the economy grow but the socio-economic burden of diseases such policies bring along is much higher.
The book though talks only about the policies which impact our heart health, it's a window to a deeper conspiracy by the State to encroach upon our free will. Thankfully, the author does not end on a pessimistic note. He details out solutions along with instances, which have helped deal with the policy lacunae in other countries as well as in India.  Read this book if you want to know how we can be the real masters of our own destiny.

'Labels like cholesterol-free are misleading'

Q How do you view the recent meeting of PepsiCo CEO with Union Minister of Food Processing Industries as there has been news about government asking the cola giant to reduce sugar content in its drinks while PepsiCo's possible participation in the mid-day meal scheme is also being talked about?

- The meeting is not surprising because Pepsi has always been the ‘posteAuthor Dinesh Sharmar boy’ of the Ministry of Food Processing Industries which champions the cause of food processing industry, ignoring its original mandate of helping farmers and overlooking health impacts of packaged junk food.  What is alarming is an open invitation extended by the present government to food industry to be a part of its nutrition delivery programmes. It is like asking a pickpocket to become cashier in a bank. For long, the industry has been eyeing the mid-day meal scheme as a means of promoting its products – colas, chips, noodles, cookies – not just in India but globally.  Any association of a cola-and-chips producer with a nutrition programme in any form is dangerous and unethical. Creator of a problem can’t be a part of the solution.

Q You are vouching for higher taxes on processed food. On the other hand, we have tobacco which has been increasingly taxed but still remains one of the biggest risk factors for heart disease. Would you say junk food also falls in the same category as people get addicted to the high salt, sugar and fat contents and high taxes may not help much?

- Tobacco, liquor and junk food are all unhealthy products yet they are legal goods, so one can’t argue that they should be banned altogether. However, demand of such products can be modulated and taxation is a means of doing this. There is evidence to this effect from many countries. In India, taxes on tobacco products have not yet reached a level where the consumer price would pinch the user. Only in this budget, the tax hike on cigarettes was steep. As regards processed and packaged food high in salt, sugar and fat, the government policy is to actively promote this industry through a plethora of direct and indirect subsidies. Such subsidies are not given to health-promoting products, fruits and vegetables. My contention is that the government’s aim should be to create a level playing field. This can be done by ending subsidies to junk food makers and taxing unhealthy products higher.

Q Growing attention to health food has led to another marketing drive bringing out a slew of costly products like multigrain flour. Is there any way we can escape the market forces and still eat good food?

- So-called healthy products being produced and marketed by food companies are the biggest irony. Food labels are being tweaked in a clever way to position products as healthy. Labels like fat-free, cholesterol-free and sugar-free are utterly misleading because these products may be free of fat or sugar but could still affect your blood cholesterol or sugar level due to presence of other ingredients. Lab analysis of noodle products has shown that most brands contained far too high sodium and too low fibre than what was claimed on labels. Instead of coming hard on such health claims, our food regulator is all set to allow ‘disease risk reduction claims’. Look at packaged rice. First you overmill the rice to make grains whiter and longer, but taking off all its nutritive coverings rich in dietary fibre. The government gives subsidy to rice mills. And then the same stuff – rice bran – is used to produce and market ‘healthy oil’. That’s the market for you.

Q Except tobacco, there has not been a civil society movement seeking policy changes related to risk factors of heart disease. The anti-junk food campaign has also been restricted to schools. What do you think is the reason for that?

- You are right. The reason for this is the fact that connection between tobacco with ill-health has been around for half a century. In India, the first health warnings on cigarettes appeared almost four decades ago. The rise of junk food is a relatively recent. Only in the past ten to fifteen years have the World Health Organisation and the United Nations become vocal about the non-communicable diseases and their risk factors. Secondly, the junk food industry is diverse and very powerful. The moment there was talk of restriction on advertising and demand for stricter labeling, the industry joined the ‘healthy products’ bandwagon and is desperately trying to ward off any regulation. The anti-junk food programme is very important but for it to succeed kids should be provided healthy alternatives in school canteens, and ads that position packaged food as a replacement of home cooked food should be regulated.

Q Do you think we are lacking Indian studies to emphasis on socio- economic loss of heart disease as compared to the gains made by growth of processed food, automobile and tobacco industries?

-To an extent yes. But I believe there is enough evidence for us to act, for policy makers to take health-promoting actions.  The health burden of tobacco industry is huge and well documented, there is evidence to show diabetes and heart disease have begun to affect productivity and cancers are ruining scores of families. These are chronic ailments for which people need lifelong medication and costly interventions. Yes, we need more studies, but that shouldn’t prevent action. On the other hand, can you tell me what is social, environmental and health cost of promoting processed food since the Ministry of Food Processing was set up?

Q You have mentioned that Indians are losing culinary skills thus increasingly depending on processed food. This trend is bound to continue due to lifestyle changes which make us spend less time at home. Is there a way out?

- Actually it is the processed food industry that is to blame for onslaught on our culinary skills. Changing lifestyles are only partly responsible. The food industry is constantly bombarding us with messages telling us that its products are better than ‘ma ke haath ka khana’ or ‘dadi ke haath ka khana’.  Ads also show kids rejecting home-cooked food for a plate of pre-cooked noodles or pasta. Not just this, a pizza maker has gone to the extent of depicting pizza delivery as a replacement of freshly cooked food supplied by legendary ‘dabbawalas’ of Mumbai. At the end of the commercial, the cart of dabbawala slips into the sea. I believe such depiction is sinister. I am sure if you conduct a survey among young kids today and ask them how curd is made, a majority would name a particular brand and say you get it in the store. A pro-health policy framework is the only way out.

Q Reading your book it seems everything is wrong with us: We eat unhealty food, there's no walking and cycling space, tobacco consumption is high and we are also genetically predisposed. During the course of research, did you also come across any positive side of Indian lifestyle because of which the crisis is not as big as it could have been?

-  Thankfully there is a lot that we can still do. Going by recent reports in business press, international food chains have not registered the kind of growth they had predicted when they came into India. Their success India has been much moderated when compared to China, Brazil or Mexico. The demand for space for cycling and public transport is likely to grow, given some recent indications about ridership of public transport in some Indian cities. There are indications that some state governments plan to promote fruits and vegetables.  Awareness level about health in general and non-communicable diseases in particular is slowly growing. These are all positive signals, on which we need to build upon.